Nicardipine versus nitroprusside for deliberate hypotension during idiopathic scoliosis repair.
OBJECTIVE
To compare coagulation, blood loss, and transfusion requirements between patients receiving nicardipine and nitroprusside for deliberate hypotension during idiopathic scoliosis repair.


METHODS
Prospective, randomized study.


METHODS
University hospital.


METHODS
51 ASA physical status I patients presenting for spine fusion for idiopathic adolescent scoliosis.


METHODS
Patients were randomized to two groups to receive nicardipine or nitroprusside to maintain mean arterial pressure (MAP) between 55 and 65 mmHg.


METHODS
Blood loss, blood transfusions, and coagulation studies (thromboelastogram and platelet aggregation) before starting vasodilator, 30 minutes and 90 minutes after starting vasodilator, and 30 minutes after stopping vasodilator, were all recorded.


RESULTS
There was no difference between the groups in blood loss [nicardipine = 1,129 cc (893 to 1,480), nitroprusside = 960 cc (704 to 1,473)] and only one patient required a nonautologous transfusion. There were no differences in prothrombin time (pT, partial thromboplastin time (pTT), platelet count, or platelet aggregation between groups. There were more episodes of severe hypotension (MAP <45 mmHg) in the nitroprusside group (0% vs. 28%, p = 0.0175). On average, patients in the nicardipine group spent 21 minutes less in the recovery room than did the nitroprusside group (p = 0.043).


CONCLUSIONS
Nitroprusside's effect on platelet aggregation produces no increase in blood loss compared with nicardipine. Nicardipine causes less transient severe hypotension than nitroprusside, although both drugs are acceptable choices for obtaining the goals of deliberate hypotension.
Department of Anesthesiology, University of Rochester School of Medicine and Dentistry, Rochester, NY 14642, USA. Stewart_Lustik@URMC.Rochester.edu
Stewart J
SJ
Lustik
Peter J
PJ
Papadakos
Kenneth V
KV
Jackman
Paul T
PT
Rubery
Karen L
KL
Kaplan
Ashwani K
AK
Chhibber
D000293:Adolescent; D001780:Blood Coagulation Tests; D016063:Blood Loss, Surgical; D001794:Blood Pressure / Q000187:drug effects; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D007023:Hypotension, Controlled; D008297:Male; D009529:Nicardipine / Q000627:therapeutic use*; D009599:Nitroprusside / Q000627:therapeutic use*; D010976:Platelet Count; D012600:Scoliosis / Q000601:surgery*; D013123:Spinal Fusion; D014665:Vasodilator Agents / Q000627:therapeutic use*
D014665:Vasodilator Agents; D009599:Nitroprusside; D009529:Nicardipine