The role of nicardipine during anesthesia and surgery

The stresses of the perioperative period often requires the use of vasoactive drugs for hemodynamic control. Nicardipine hydrochloride is a short-acting dihydropyridine calcium antagonist with a unique configuration and characteristics that make it attractive for intraoperative and postoperative use. Nicardipine has highly specific modes of action, producing coronary and systemic vasodilation, a reduction in coronary spasm, and cardioprotection not consistently seen with other calcium antagonists. It produces a rapid decrease in blood pressure without severe hypotension, sinus arrest, cardiac depression, or clinically significant tachycardia, while it increases myocardial contractility and cardiac output. Nicardipine dilates the cerebral vasculature but does not significantly increase cerebrospinal fluid pressure in surgical patients without intracranial lesions. Unlike nifedipine, which must be administered orally or sublingually, nicardipine is stable in parenteral formulation ("light stable and water soluble") and can be given intravenously. The distinctive characteristics of nicardipine suggest that anesthesiologists might find it preferable to other vasodilators or calcium antagonists for hemodynamic control during and after surgery.