Nicardipine for controlled hypotension during orthognathic surgery.

Nicardipine is the first intravenously administered dihydropyridine calcium channel blocker. Its primary physiologic actions include vasodilatation with limited effects on the inotropic and dromotropic function of the myocardium. Although it was used in the past as an agent for controlled hypotension during orthopedic surgery in adults and children, we are unaware of reports concerning its use for controlled hypotension during maxillofacial surgery. We present our experience with nicardipine as an agent for controlled hypotension during orthognathic surgery in nine adolescents ranging in age from 11 to 16 years and in weight from 39 to 61 kg. Following induction of general anesthesia, nicardipine was started at 5 micrograms/kg per minute. The target mean arterial pressure of 50 to 65 mmHg was reached in 2 to 12 minutes (mean 5.5 minutes). Intraoperative infusion requirements to maintain the target mean arterial pressure varied from 1 to 7 micrograms/kg per minute (mean 3.6 micrograms/kg per minute). No adverse effects related to nicardipine were noted. Our preliminary experience suggests the efficacy of nicardipine for controlled hypotension in adolescents during orthognathic surgery. Future studies are required to determine its advantages and disadvantages over more commonly used agents such as sodium nitroprusside or adrenergic antagonists.