Avramov M N, Stool L A, White P F, Husain M M
Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas 75235-9068, USA.
J Clin Anesth. 1998 Aug;10(5):394-400. doi: 10.1016/s0952-8180(98)00052-x.
To examine the acute hemodynamic effects of intravenous (i.v.) nicardipine and its ability to attenuate the hyperdynamic response to electroconvulsive therapy (ECT), when used alone or in combination with labetalol.
Prospective, randomized, double-blind, positive-control, clinical investigation.
University hospital.
36 patients undergoing ECT.
In a series of three studies, the hemodynamic effects of nicardipine were assessed prior to, during, and after ECT. After administration of glycopyrrolate 0.1 mg i.v., placebo (saline) or nicardipine was administered by rapid infusion (1, 2.5, 5, 10, and 15 mg) or bolus injection (1.25, 2.5, and 5 mg), either alone or in combination with labetalol 10 mg i.v. Unconsciousness was induced with methohexital 1 mg/kg i.v.; succinylcholine 1.2 to 1.5 mg/kg i.v. was administered for muscle relaxation. A bilateral electrical stimulus was delivered and the durations of motor and electroencephalographic (EEG) seizures were noted.
Mean arterial pressure (MAP) and heart rate (HR) values were recorded at 1- to 5-minute intervals throughout the study period. When administered as a rapid infusion, nicardipine 5 mg i.v. produced a significant decrease in MAP; however, nicardipine dosages of 10 to 15 mg i.v. did not produce a significantly greater decrease in MAP than 5 mg. Bolus administration of nicardipine 1.25 to 5 mg produced a rapid onset of its hemodynamic effects without exacerbating the cardiovascular depressant effects of methohexital. However, the decrease in MAP was accompanied by an increase in HR after administration of the 5 mg i.v. bolus dose. The acute hyperdynamic response to ECT was most effectively controlled by nicardipine 2.5 to 5 mg i.v. bolus, in combination with labetalol 10 mg i.v. Seizure duration was not significantly altered by the use of nicardipine as part of the anesthetic regimen for ECT.
Nicardipine 2.5 mg i.v. bolus in combination with labetalol 10 mg i.v. was the most effective pretreatment regimen for preventing the acute hyperdynamic response to ECT. However, this combination produced a 20% decrease in MAP immediately prior to ECT and a lower MAP at the time of discharge.
探讨静脉注射尼卡地平的急性血流动力学效应，以及其单独使用或与拉贝洛尔联合使用时减弱电休克治疗（ECT）引起的高动力反应的能力。
前瞻性、随机、双盲、阳性对照临床研究。
大学医院。
36例接受ECT治疗的患者。
在一系列三项研究中，评估了ECT治疗前、治疗期间和治疗后尼卡地平的血流动力学效应。静脉注射0.1mg格隆溴铵后，通过快速输注（1、2.5、5、10和15mg）或大剂量注射（1.25、2.5和5mg）单独或与静脉注射10mg拉贝洛尔联合给予安慰剂（生理盐水）或尼卡地平。静脉注射1mg/kg美索比妥诱导意识丧失；静脉注射1.2至1.5mg/kg琥珀酰胆碱用于肌肉松弛。给予双侧电刺激并记录运动和脑电图（EEG）癫痫发作的持续时间。
在整个研究期间，每隔1至5分钟记录平均动脉压（MAP）和心率（HR）值。静脉快速输注5mg尼卡地平可使MAP显著降低；然而，静脉注射10至15mg尼卡地平引起的MAP降低幅度并不比5mg时显著更大。静脉大剂量注射1.25至5mg尼卡地平可使其血流动力学效应迅速起效，且不会加重美索比妥的心血管抑制作用。然而，静脉注射5mg大剂量后，MAP降低的同时HR升高。静脉注射2.5至5mg尼卡地平联合静脉注射10mg拉贝洛尔能最有效地控制ECT引起的急性高动力反应。将尼卡地平作为ECT麻醉方案的一部分使用时，癫痫发作持续时间无显著改变。
静脉注射2.5mg尼卡地平联合静脉注射10mg拉贝洛尔是预防ECT急性高动力反应最有效的预处理方案。然而，这种联合用药在ECT治疗前即刻使MAP降低20%，且出院时MAP较低。
