Effect of nicardipine and diltiazem on internal carotid artery blood flow velocity and local cerebral blood flow during cerebral aneurysm surgery for subarachnoid hemorrhage.
OBJECTIVE
To determine the hemodynamic effects of a bolus injection of nicardipine 1 mg or diltiazem 5 mg on local cerebral blood flow (LCBF) and internal carotid blood flow velocity (ICBFV) with isoflurane anesthesia.


METHODS
Randomized study.


METHODS
Inpatient neurosurgery and anesthesia clinic at a city hospital.


METHODS
26 patients with subarachnoid hemorrhage who were scheduled for cerebral aneurysm clipping.


METHODS
A bolus injection of either nicardipine or diltiazem was administered to patients whose systolic blood pressure increased to over 150 mmHg after opening of the dura.


RESULTS
After the bolus injection, both drugs rapidly decreased arterial blood pressure. Nicardipine increased LCBF [before injection, 42.1 +/- 12.3 ml/100 g/min; after injection, 47 +/- 10.7 ml/100g/min; (p < 0.05 vs control); after recovery, 42.4 +/- 11.1 cm/sec], but diltiazem did not change LCBF. Nicardipine 1 mg moderately increased ICBFV [before injection, 34.2 +/- 9.3 cm/sec; after injection, 40.6 +/- 8.7 cm/sec (p < 0.01 vs. control); after recovery, 34.1 +/- 8.9 cm/sec], but diltiazem did not change ICBFV. In addition, venous partial oxygen pressure and saturation of the internal jugular did not change throughout the study. There was a close correlation between presurgical neurologic status and LCBF (rs = -0.743; p < 0.01) and ICBFV (rs = -0.721; p < 0.01).


CONCLUSIONS
Nicardipine increased LCBF and ICBFV, but diltiazem did not change either. These results suggest that both drugs are useful and safe for the treatment of intraoperative hypertension during cerebral aneurysm surgery.
Abe
K
K
Department of Anesthesia, Osaka Police Hospital, Japan.
Iwanaga
H
H
Inada
E
E
D000328:Adult; D000368:Aged; D001783:Blood Flow Velocity / Q000187:drug effects; D001794:Blood Pressure / Q000187:drug effects; D002343:Carotid Artery, Internal / Q000187:drug effects* / Q000502:physiology*; D002560:Cerebrovascular Circulation / Q000187:drug effects*; D004110:Diltiazem / Q000494:pharmacology* / Q000627:therapeutic use; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy; D002532:Intracranial Aneurysm / Q000150:complications / Q000601:surgery*; D007431:Intraoperative Complications / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D009529:Nicardipine / Q000494:pharmacology* / Q000627:therapeutic use; D010100:Oxygen / Q000097:blood; D012039:Regional Blood Flow / Q000187:drug effects; D013345:Subarachnoid Hemorrhage / Q000209:etiology / Q000601:surgery*
D009529:Nicardipine; D004110:Diltiazem; D010100:Oxygen