title: Nicardipine versus nitroprusside for controlled hypotension during spinal surgery in adolescents.
abstract: Nicardipine or nitroprusside was used to induce controlled hypotension in healthy adolescents with idiopathic scoliosis undergoing spinal fusion. Twenty patients were randomly assigned to the nitroprusside (N) or nicardipine (C) group. All patients received a standardized anesthetic. A target mean arterial blood pressure (MAP) of 60 mm Hg was achieved by varying the vasoactive infusions only. Moderate hemodilution (PCV = 25) and intraoperative blood salvage were used in all cases. Hemodynamic variables, blood loss, occurrence of reflex tachycardia, and reversibility of the hypotensive state were compared between the two groups. Significant differences were observed between the two groups in the amount of blood loss and reversibility of the hypotensive state. Group C had less blood loss (761 +/- 199 mL) than Group N (1297.5 +/- 264, P < or = .05). Time to restoration of baseline MAP was longer with Group C (26.8 +/- 4.0 min) than Group N (7.3 +/- 1.1 min, P < or = 0.001). Both drugs rapidly achieved a stable, controlled hypotensive state and an acceptable operating field. There was no statistically significant difference between groups with respect to the amount of crystalloid administered or urine output. These results suggest that nicardipine is a safe, effective drug for controlled hypotension in this population and that it may offer the significant advantage of reduced blood loss in these patients.
authors.affiliation: Department of Orthopedics, Vanderbilt Children's Hospital, Vanderbilt University Medical Center, Nashville, Tennessee, 37232-2591 USA.
authors.forename: S L
authors.initials: SL
authors.lastname: Hersey
authors.forename: N E
authors.initials: NE
authors.lastname: O'Dell
authors.forename: S
authors.initials: S
authors.lastname: Lowe
authors.forename: G
authors.initials: G
authors.lastname: Rasmussen
authors.forename: J D
authors.initials: JD
authors.lastname: Tobias
authors.forename: J K
authors.initials: JK
authors.lastname: Deshpande
authors.forename: G
authors.initials: G
authors.lastname: Mencio
authors.forename: N
authors.initials: N
authors.lastname: Green
mesh_terms: D000293:Adolescent; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects; D005260:Female; D006801:Humans; D007023:Hypotension, Controlled; D008297:Male; D009529:Nicardipine / Q000627:therapeutic use*; D009599:Nitroprusside / Q000627:therapeutic use*; D011446:Prospective Studies; D012600:Scoliosis / Q000601:surgery; D013123:Spinal Fusion / Q000379:methods*; D014665:Vasodilator Agents / Q000627:therapeutic use*
chemical_list: D000959:Antihypertensive Agents; D014665:Vasodilator Agents; D009599:Nitroprusside; D009529:Nicardipine