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NEUROSURGICAL ANESTHESIA

A Comparative Study Between a Calcium Channel Blocker (Nicardipine) and a Combined -ß-Blocker (Labetalol) for the Control of Emergence Hypertension During Craniotomy for Tumor Surgery

Ronald A. Kross, MD^*, Enrico Ferri, MD, Denis Leung, PhD^*, Margaret Pratila, MD^*, Clara Broad, MD^*, Michele Veronesi, MD, and Jose A. Melendez, MD^*

*Departments of Anesthesiology and Critical Care Medicine and Biostatistics, Memorial Sloan-Kettering Cancer Center and Weil Medical College of Cornell University, New York, New York; and Department of Anesthesiology, University of Ferrara, Ferrara, Italy

Address correspondence to Ronald A. Kross, MD, Anesthesiology and Critical Care Medicine, Memorial Sloan-Kettering Cancer Center, 1275 York Ave., New York, 100021.

We compared the efficacy of the combination of enalaprilat/labetalol with that of enalaprilat/nicardipine to prevent emergence postcraniotomy hypertension. A prospective, randomized open labeled clinical trial was designed to compare the incidence of breakthrough hypertension (systolic blood pressure [SBP] > 140 mm Hg) and adverse effects (hypotension, tachycardia, and bradycardia) between the two drug combinations. Secondarily, the effects of the drugs on SBP, mean blood pressure, and diastolic blood pressure were evaluated over the course of the study. Forty-two patients received enalaprilat 1.25 mg IV at dural closure followed by either multidose nicardipine 2 mg IV or labetalol 5 mg IV to maintain the SBP below 140 mm Hg. SBP was similarly controlled in both groups. There was a marginally smaller incidence of failures and adverse effects with labetalol. Blood pressure profiles were similar for both groups.

Implications: When given in combination with enalaprilat, nicardipine is a good alternative to labetalol for controlling emergence hypertension after craniotomies.

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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