Intravenous nicardipine does not alter hepatic blood flow after orthotopic liver transplant.
OBJECTIVE
To evaluate the effects of nicardipine on hepatic blood flow in patients with recent liver transplants. Secondly, to evaluate the liver extraction of nicardipine in order to determine the influence of liver transplantation on its disposition.


METHODS
Prospective self-controlled clinical study.


METHODS
University hospital intensive care unit.


METHODS
Eight patients in the early postoperative period of orthotopic liver transplantation.


RESULTS
Patients were given 5 mg of i.v. nicardipine. Systemic and splanchnic haemodynamic and metabolic parameters were measured before nicardipine administration (T0) and at 5 min (T1), 30 min (T2), and 120 min (T3) after administration. A catheter was inserted into a hepatic vein to determine the total hepatic blood flow (HBF) and the hepatic extraction coefficient of nicardipine. Nicardipine caused no significant changes in HBF, oxygen delivery, oxygen uptake, hepatic venous oxygen saturation, or the hepatic venous partial pressure of oxygen. Likewise, neither blood lactate concentrations nor arterial and hepatic venous lactate-pyruvate ratios were modified by nicardipine. The hepatic extraction coefficient of nicardipine was approximately 0.70 in the first 3 min after complete infusion, then decreased and remained stable at approximately 0.50, showing a non-linear first-pass metabolism pattern.


CONCLUSIONS
Nicardipine administration after liver transplantation appears to have no deleterious effects on HBF. Nicardipine can be classified as a drug of intermediate hepatic extraction coefficient, whose elimination partly depends on hepatic enzyme activity.
Raucoules-Aimé
M
M
Département d' Anesthésia-Réanimation, Hôpital Saint-Roch, Nice, France.
Drici
M
M
Goubaux
B
B
Labib
Y
Y
Ichai
C
C
Gugenheim
J
J
Grimaud
D
D
D000328:Adult; D000959:Antihypertensive Agents / Q000493:pharmacokinetics / Q000627:therapeutic use*; D016903:Drug Monitoring; D005260:Female; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D007262:Infusions, Intravenous; D008099:Liver / Q000378:metabolism*; D008102:Liver Circulation / Q000187:drug effects*; D016031:Liver Transplantation / Q000502:physiology*; D008297:Male; D008657:Metabolic Clearance Rate; D008875:Middle Aged; D009529:Nicardipine / Q000493:pharmacokinetics / Q000627:therapeutic use*; D011184:Postoperative Period; D011446:Prospective Studies
D000959:Antihypertensive Agents; D009529:Nicardipine