Search Results (4)

Introduction: Spontaneous intracerebral hemorrhage (sICH) is a devastating type of stroke. Blood pressure reduction is crucial in its management and is well mentioned in current guidelines; however, the role of blood pressure variability (BPV) in emergency departments (EDs) has not been well studied. This study aimed to identify predictors of lower systolic blood pressure (SBP) (≤160 mmHg) and BPV at ED discharge and course, respectively. Methods: This is a retrospective study of prospectively collected data at a quaternary care center of adult patients diagnosed and treated with sICH between 1 January 2017 and 31 December 2020. The primary outcome of interest was SBP at ED discharge; this was divided into two groups: a control group composed of patients discharged with an SBP ≤ 160 mmHg and a comparison group composed of patients discharged with an SBP > 160 mmHg. Secondary outcomes included measures of BPV, specifically successive variation (SBPSV), and standard deviation (SBPSD) during ED course. Machine learning algorithms were used to identify predictors of SBP at ED discharge: SBPSV and SBPSV. Results: This study evaluated 142 patients, of which 85 (60%) were discharged with SBP ≤ 160 mmHg. The mean SBP at ED discharge was 133 (±16.1) mmHg for the control group and 184 (±21.3) for the comparison group (difference −51; 95% CI −58 to −45; p < 0.001). The top five predictors for the primary outcome identified by machine learning included initial SBP at ED triage, serum sodium, clevidipine administration, serum glucose, and serum creatinine. Predictors for secondary outcome included mechanical ventilation, serum glucose, and initial SBP at ED triage. Conclusion: Initial SBP was the top predictor of achieving a goal SBP ≤160 mmHg at ED discharge in patients with sICH. Predictors of increased BPV included mechanical ventilation, elevated serum glucose, and high initial SBP in the ED. While further studies are necessary to confirm our observations, clinicians should consider these factors when they care for patients with sICH. Full article

Background/Objectives: Adrenalectomy for pheochromocytoma presents a risk due to catecholamine discharge, leading to perioperative hemodynamic instability and potential fatality. Recommendations stress surgical caution and care in referral centers. Laparoscopic and robotic adrenalectomy advancements have decreased perioperative risks, with robotic access deemed advantageous for larger tumors. This study aimed to assess if surgical technique and a new clevidipine-based perioperative protocol could improve hemodynamic stability. Methods: All robotic adrenalectomies treated in recent years (50) were included (Group A). A control group of 50 laparoscopic adrenalectomies (Group B) was also included. Results: In Group A, 7 patients had a BMI > 30 (14%), and 20 patients (40%) had pheochromocytomas > 5 cm in size. During surgery, 22 patients (44%) had systolic blood pressure/SBP ≥ 160 mmHg, and 18 patients (36%) had heart rate/HR ≥ 110 bpm. A total of 44 patients (88%) were treated perioperatively with clevidipine, 32 (64%) required amines perioperatively, and 8 (16%) did not require transfer to intensive care. In Group B, 2 patients had BMI > 30 (4%), 12 (24%) had pheochromocytomas > 5 cm in size, 35 (70%) had SBP ≥ 160 mmHg, 16 patients (32%) had HR ≥ 110 bpm, 23 (46%) patients required amines perioperatively, and all were transferred to intensive care after surgery. In addition, 11 (22%) patients were treated with clevidipine. In both groups, MAP < 60 mmHg was equivalent (62% vs. 60%). Conclusions: The clevidipine-based protocol, combined with robotic adrenalectomy, notably for larger tumors, potentially improves perioperative hemodynamic stability, reducing postoperative intensive care needs. This combination could represent an advancement in managing those patients. Full article

Hypertension represents a major risk factor for cardiovascular events, associating with vascular hypertrophy and dysfunction in resistance vessels. Clevidipine is a novel antihypertensive drug working as a selective calcium channel antagonist with an ultra-short half-life that lowers arterial blood pressure by reducing systemic arterial resistance. The aim was to assess the effect of clevidipine on the hypertrophic vessels of profilin1 hypertensive transgenic mice compared to sodium nitroprusside (SNP) and labetalol using wire myograph techniques. The effects of clevidipine, SNP and labetalol on the hypertrophic vessels were studied on mesenteric arterial function from 8 profilin1 hypertrophic mice and eight non-transgenic controls. Our results showed a significant difference between the effects of the three drugs on the hypertrophic mesenteric arteries of transgenic profilin1 mice compared to the non-transgenic controls. The half maximal effective concentration (EC₅₀) of clevidipine, SNP and labetalol in profilin1 mice (1.90 ± 0.05, 0.97 ± 0.07, 2.80 ± 0.05 nM, respectively) were significantly higher than the EC₅₀ in non-transgenic controls (0.91 ± 0.06, 0.32 ± 0.06, 0.80 ± 0.09 nM, respectively). Moreover, the increase in the EC₅₀ for clevidipine (2-fold) to produce the same effect on both normal and hypertrophic arteries was less than that of SNP (3-fold) and labetalol (3.5-fold). Therefore, we concluded clevidipine exhibited the lowest dose shift to relax the hypertrophic vessels compared to SNP and labetalol in the profilin1 hypertrophic animal mouse model. Full article

Various pharmacologic agents have been used for perioperative BP control in pediatric patients, including sodium nitroprusside, nitroglycerin, β-adrenergic antagonists, fenoldopam, and calcium channel antagonists. Of the calcium antagonists, the majority of the clinical experience remains with the dihydropyridine nicardipine. Clevidipine is a short-acting, intravenous calcium channel antagonist of the dihydropyridine class. It undergoes rapid metabolism by non-specific blood and tissue esterases with a half-life of less than 1 minute. As a dihydropyridine, its cellular and end-organ effects parallel those of nicardipine. The clevidipine trials in the adult population have demonstrated efficacy in rapidly controlling BP in various clinical scenarios with a favorable adverse effect profile similar to nicardipine. Data from large clinical trials regarding the safety and efficacy of clevidipine in children is lacking. This manuscript aims to review the commonly used pharmacologic agents for perioperative BP control in children, discuss the role of calcium channel antagonists such as nicardipine, and outline the preliminary data regarding clevidipine in the pediatric population. Full article