title: Efficacy of clevidipine in controlling perioperative hypertension in neurosurgical patients: initial single-center experience.
abstract: BACKGROUND
  Acute blood pressure (BP) elevations in neurosurgical patients are associated with serious neurologic, cardiovascular, or surgical site complications. Clevidipine, an ultra-short-acting dihydropyridine calcium antagonist, has been shown to be efficacious and safe for acute hypertension in cardiac surgery. This study assessed the efficacy and safety of clevidipine in controlling perioperative hypertension in the neurosurgical setting.
  
  
  METHODS
  Patients scheduled for intracranial surgery were prospectively enrolled after giving consent. Clevidipine (0.5 mg/mL in 20% lipid solution, which was to be initiated at 10 mg/h and titrated to effect) was administered as the primary antihypertensive agent for perioperative hypertension, with target BPs of less than 130 mm Hg. Other vasoactive drugs were administered as needed for treating systolic BP (SBP) less than 90 mm Hg or greater than 130 mm Hg. The primary study endpoint was the proportion of patients not requiring rescue antihypertensives to maintain target SBP (<130 mm Hg).
  
  
  RESULTS
  Twenty-two patients were enrolled. One patient did not require antihypertensive therapy. Seventeen patients (17 of 21, 81%) were treated with clevidipine alone; one received clevidipine in the postanesthesia care unit only. Twenty-eight hypertensive episodes (defined as any new acute BP elevation requiring clevidipine initiation) were documented. SBP was reduced to target level within 15 minutes in 22 of 28 episodes (78.6%). Two mild hypotensive episodes occurred after the initiation of clevidipine infusion; these transient decreases in BP were treated with vasoactive drugs and resolved within 5 minutes.
  
  
  CONCLUSIONS
  Clevidipine is effective and safe for perioperative hypertension in patients undergoing intracranial procedures. Rapid control of BP is possible with higher starting doses. Drug effects resolved rapidly after drug discontinuation.
authors.affiliation: Department of Anesthesiology, New York University Medical Center, New York, NY 10016, USA. alex.bekker@nyumc.org
authors.forename: Alex
authors.initials: A
authors.lastname: Bekker
authors.forename: Sorosch
authors.initials: S
authors.lastname: Didehvar
authors.forename: Sunmi
authors.initials: S
authors.lastname: Kim
authors.forename: John G
authors.initials: JG
authors.lastname: Golfinos
authors.forename: Erik
authors.initials: E
authors.lastname: Parker
authors.forename: Andrew
authors.initials: A
authors.lastname: Sapson
authors.forename: Michael
authors.initials: M
authors.lastname: Haile
authors.forename: Richard
authors.initials: R
authors.lastname: Kline
authors.forename: Mitchell
authors.initials: M
authors.lastname: Lee
mesh_terms: D000768:Anesthesia, General; D001794:Blood Pressure / Q000502:physiology; D002121:Calcium Channel Blockers / Q000493:pharmacokinetics / Q000627:therapeutic use*; D003422:Critical Care; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures; D059035:Perioperative Period; D011725:Pyridines / Q000493:pharmacokinetics / Q000627:therapeutic use*; D016896:Treatment Outcome; D014664:Vasodilation / Q000187:drug effects
chemical_list: D002121:Calcium Channel Blockers; D011725:Pyridines; C118563:clevidipine