Clinical considerations for the use of intravenous nicardipine in the treatment of postoperative hypertension.

The incidence of postoperative hypertension after both cardiac and noncardiac surgery is a major concern. alpha-Adrenergic-blocking drugs, such as phentolamine, and direct-acting vasodilators, such as nitroglycerin and nitroprusside, are commonly used to treat hypertension. Nifedipine, a calcium channel blocker, may also be used, but because no intravenous preparation is available, its effects are not titratable. A new short-acting calcium channel blocker, nicardipine, is a potent vasodilator and produces more selective responses in the coronary versus the systemic vascular circulation. It is an effective cerebral vasodilator, increasing cerebral blood flow and oxygen delivery. Nicardipine can be administered as an intravenous loading infusion of 10 to 15 mg/hr for 25 minutes, followed by a maintenance infusion of 3 to 5 mg/hr. Nicardipine has a short duration factor, is easily titratable and is as effective as nitroglycerin or nitroprusside in the control of hypertension. In summary, nicardipine has many properties of an ideal drug for the treatment of postoperative hypertension.