Continuous nicardipine infusion to control blood pressure after evacuation of acute cerebral hemorrhage.
OBJECTIVE
To explore the long-term effects of the calcium antagonist, nicardipine, on cerebral hemodynamics in patients with acute cerebral hemorrhage, we investigated the effects of nicardipine infusion on intracranial pressure (ICP), middle cerebral arterial blood flow velocity (Vmca) , and computed tomographical (CT) findings of bleeding and edema.


METHODS
Twenty-two patients with acute cerebral hemorrhage were infused with nicardipine for > 72 hr to decrease blood pressure. Blood pressure, heart rate, conscious level, Vmca, pulsatility index (PI, using transcranial Doppler), ICP, cerebral perfusion pressure (CPP) and platelet counts were monitored. CT examination was also performed to detect the changes of bleeding (hematoma) and/or brain edema.


RESULTS
Blood pressure decreased (20 to 30% from control, P < 0.05) without any changes in heart rate. Platelet count did not change neither did Vmca and PI change on either the intact or injured side. The ICP decreased 24 hr after the end of infusion from 30 +/- 12 mmHg to 20 +/- 9 mmHg (P = 0.036) but was still higher than normal. The CPP decreased at 24 hr (75 +/- 14 mmHg, P = 0.026) and 72 hr (73 +/- 15 mmHg, P = 0.024) from the baseline (99 +/- 17 mmHg). Conscious level improved but not significantly and CT findings did not show any exacerbation in bleeding or edema.


CONCLUSIONS
In patients with acute cerebral hemorrhage, nicardipine infusion to decrease blood pressure by 20 to 30% had no effect on Vmca, ICP, cerebral bleeding and edema, but decreased CPP.
Nishiyama
T
T
Department of Surgical Center, The Institute of Medical Science, The University of Tokyo, Japan. nishiyam@ims.u-tokyo.ac.jp
Yokoyama
T
T
Matsukawa
T
T
Hanaoka
K
K
D000368:Aged; D001794:Blood Pressure / Q000187:drug effects*; D001929:Brain Edema / Q000188:drug therapy / Q000503:physiopathology; D002121:Calcium Channel Blockers / Q000008:administration & dosage / Q000627:therapeutic use*; D002543:Cerebral Hemorrhage / Q000503:physiopathology* / Q000628:therapy; D002560:Cerebrovascular Circulation / Q000187:drug effects; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D007427:Intracranial Pressure / Q000187:drug effects; D008297:Male; D008875:Middle Aged; D020768:Middle Cerebral Artery / Q000502:physiology; D009529:Nicardipine / Q000008:administration & dosage / Q000627:therapeutic use*; D010976:Platelet Count; D014057:Tomography, X-Ray Computed
D002121:Calcium Channel Blockers; D009529:Nicardipine