DELIBERATE HYPOTENSION WITH NICARDIPINE OR NITROPRUSSIDE DURING TOTAL HIP-ARTHROPLASTY

To induce deliberate hypotension during anesthesia, nicardipine was administered to patients undergoing total hip arthroplasty and was randomly compared with nitroprusside. Hemodynamic measurements were performed before and 10, 20, 30, and 60 min after starting to administer either nicardipine (n = 12) or nitroprusside (n = 12) (B, T1, T2, T3, and T4, respectively); at the end of drug infusion (T5); and 10, 20, and 60 min later (T6, T7, and T8, respectively). Plasma renin activity and catecholamine levels were measured at B, T1, T5, T6, and T7. In addition, plasma nicardipine concentration was measured in five patients at T1, T2, T5, T7, and T8. As with nitroprusside, nicardipine administration (1-3-mu-g.kg-1.min-1, after a titration dose of 4.7 +/- 1.5 mg) resulted in hypotension (up to -34% +/- 3%), a decrease in systemic vascular resistances (up to -49% +/- 4%), and increases in heart rate (up to + 17% +/- 6%), cardiac index (up to + 37% +/- 8%), plasma norepinephrine (up to + 63% +/- 17%) and epinephrine (up to +232% +/- 68%) levels, and plasma renin activity (up to +336% +/- 207%). Ten and 20 minutes after discontinuation of the hypotensive drug, nicardipine led to persistent vasodilation and hypotension, which differed significantly from the hypertensive rebound observed after nitroprusside discontinuation, despite a similar increase in plasma renin activity and catecholamine levels. Our results indicate that after the infusion was terminated, the nicardipine-induced vasodilation was opposed to the vasoconstrictive effects of angiotensin II and catecholamines, thus avoiding hypertensive rebound. During infusion, plasma nicardipine concentration was 89 +/- 14 (T1), 88 +/- 19 (T2), and 205 +/- 52 ng/mL (T5); and after its discontinuation, 88 +/- 10 (T7) and 31 +/- 3 ng/mL (T8), i.e., effective therapeutic levels. We conclude that nicardipine can be used to induce deliberate hypotension during total hip arthroplasty but results in cumulative effects that persist after the discontinuation of infusion, with a possibility of postoperative hypotension.