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NEUROSURGICAL ANESTHESIA

The Effects of Nicardipine on Dynamic Cerebral Autoregulation in Patients Anesthetized with Propofol and Fentanyl

Hiroshi Endoh, MD, PhD^*, Tadayuki Honda, MD, PhD^*, Noboru Komura, MD, Chieko Shibue, MD, Ippei Watanabe, MD, and Koki Shimoji, MD, PhD, FRCA

Departments of *Emergency and Critical Care Medicine and Anesthesiology, Niigata University School of Medicine, Niigata, Japan

Address correspondence and reprint requests to Hiroshi Endoh, MD, PhD, Department of Emergency and Critical Care Medicine, Niigata University School of Medicine, 1-757 Asahimachi, Niigata 951-8122, Japan. Address e-mail to endoh{at}med.niigata-u.ac.jp

We investigated the effects of nicardipine on dynamic cerebral pressure autoregulation in 13 normal adult patients undergoing gynecologic or orthopedic surgery. Anesthesia was induced and maintained with propofol and fentanyl. Hypotension to a mean arterial pressure of 60–65 mm Hg was induced and maintained with a continuous infusion of nicardipine. Time-averaged mean blood flow velocity in the right middle cerebral artery was measured continuously by using transcranial Doppler ultrasonography. The cerebral autoregulatory responses were activated by releasing thigh cuffs. The actual blood flow velocity in the right middle cerebral artery response to acute change in mean arterial pressure was fitted to 1 of 10 computer-generated curves to determine the dynamic rate of cerebral autoregulation (dRoR), and the best fitting curve was used. The autoregulation test was repeated until two values of dRoR were obtained at baseline and during induced hypotension. Nicardipine significantly reduced dRoR values of 13.1% ± 3.6%/s at baseline to 8.3% ± 2.6%/s during hypotension (P < 0.01). During deliberate hypotension induced by nicardipine, the cerebral dynamic autoregulatory response is impaired in normal adult patients.

Implications: During deliberate hypotension induced by nicardipine, the cerebral dynamic autoregulatory response is impaired in normal adult patients.

This article has been cited by other articles:

				K. Nagase, K. Ando-Nagase, and H. Endoh To Cite or Not to Cite * Response Anesth. Analg., October 1, 2002; 95(4): 1127 - 1128. [Full Text] [PDF]

				H. Endoh, T. Honda, S. Ohashi, S. Hida, C. Shibue, and N. Komura The Influence of Nicardipine-, Nitroglycerin-, and Prostaglandin E1-Induced Hypotension on Cerebral Pressure Autoregulation in Adult Patients During Propofol-Fentanyl Anesthesia Anesth. Analg., January 1, 2002; 94(1): 169 - 173. [Abstract] [Full Text] [PDF]

Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999