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Abstract

Background

Postoperative hypertension after cardiac surgery is associated with substantial morbidity. Both sodium nitroprusside (SNP) and nicardipine (NIC) are effective in its management. Outcomes data for NIC and SNP in persons undergoing cardiac surgery are limited, and there are no data characterizing the influence of drug choice on postoperative costs.

Objective

Our aim was to compare the effectiveness of NIC versus SNP in the management of hypertension after cardiac surgery and evaluate the influence of drug choice on postoperative costs.

Methods

We conducted a retrospective, cohort study using our hospital's financial and electronic medical records. Adults admitted to a cardiothoracic surgical intensive care unit after coronary artery bypass grafting (CABG) and/or valve surgery who developed hypertension requiring ≥30 minutes of NIC or SNP were included. We evaluated drug effectiveness by assessing infusion rate stability, blood pressure and heart rate, and concomitant antihypertensive agent use. Activity-based postoperative costs were compared between study groups.

Results

One hundred twelve subjects were included (NIC = 72, SNP = 40). Hypertension-related demographics were balanced between the groups. NIC was associated with improved infusion rate stability that required fewer dose changes per hour (1.2 ± 1.6) versus SNP (1.7 ± 1.8) (P = .004). Heart rates and blood pressures did not differ significantly. The number of antihypertensive medications used before and during the NIC or SNP infusions was the same. However, persons who were prescribed SNP required significantly more medications to manage blood pressure after infusions were discontinued (P = .001). NIC use did not significantly increase postoperative cost. NIC use may be associated with cost increases in isolated CABG but with cost savings in isolated valve or combined CABG/valve surgeries; however, these differences were not statistically significant.

Conclusions

Blood pressure was equally controlled using NIC or SNP. NIC was associated with improved infusion rate stability. Despite a higher acquisition cost, NIC did not significantly influence postoperative costs. Larger, prospective cost-effective analyses in surgical subgroups are needed.

Keywords

coronary artery bypass health care economics heart valves hypertension nicardpine nitroprusside

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References

Lloyd-Jones

Adams

R.J.

Brown

T.M.

; on behalf of the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics—2010 update: a report from the American Heart Association. Circulation. 2010; 121: e46–e215. doi: 10.1161/CIRCULATIONAHA.109.192666

Estafanous

F.G.

Tarazi

R.C.

Systemic arterial hypertension associated with cardiac surgery. Am J Cardiol. 1980; 46: 685–694.

Wallach

Karp

R.B.

Reves

J.G.

Oparil

Smith

L.R.

James

T.N.

Pathogenesis of paroxysmal hypertension developing during and after coronary artery bypass surgery: a study of hemodynamic and humoral factors. Am J Cardiol. 1980; 46: 559–565.

Fremes

S.E.

Weisel

R.D.

Baird

R.J.

Effects of postoperative hypertension and its treatment. J Thorac Cardiovasc Surg. 1983; 86: 47–56.

Weinstein

G.S.

Zabetakis

P.M.

Clavel

The renin-angiotensin system is not responsible for hypertension following coronary artery bypass grafting. Ann Thorac Surg. 1987; 43: 74–77.

Cruise

C.J.

Skrobik

Webster

R.E.

Marquez-Julio

David

T.E.

Intravenous labetalol versus sodium nitroprusside for treatment of hypertension postcoronary bypass surgery. Anesthesiology. 1989; 71: 835–839.

Roberts

A.J.

Niarchos

A.P.

Subramanian

V.A.

Systemic hypertension associated with coronary artery bypass surgery: predisposing factors, hemodynamic characteristics, humoral profile, and treatment. J Thorac Cardiovasc Surg. 1977; 74: 846–859.

Cheung

A.T.

Exploring an optimum intra/postoperative management strategy for acute hypertension in the cardiac surgery patient. J Card Surg. 2006; 21: S8–S14.

Aronson

Boisvert

Lapp

Isolated systolic hypertension is associated with adverse outcomes from coronary artery bypass grafting surgery. Anesth Analg. 2002; 94: 1079–1084.

10.

Reich

D.L.

Bennett-Guerrero

Bodian

C.A.

Hossain

Winfree

Krol

Intraoperative tachycardia and hypertension are independently associated with adverse outcome in noncardiac surgery of long duration. Anesth Analg. 2002; 95: 273–277.

11.

Weiss

S.J.

Longnecker

D.E.

Perioperative hypertension: an overview. Coronary Artery Dis. 1993; 4: 401–406.

12.

Charlson

M.E.

MacKenzie

C.R.

Gold

J.P.

Ales

K.L.

Topkins

Shires

G.T.

Intraoperative blood pressure. What patterns identify patients at risk for postoperative complications?

Ann Surg. 1990; 212: 567–580.

13.

Charlson

M.E.

MacKenzie

C.R.

Gold

J.P.

Ales

K.L.

Topkins

Shires

G.T.

The preoperative and intraoperative hemodynamic predictors of postoperative myocardial infarction or ischemia in patients undergoing noncardiac surgery. Ann Surg. 1989; 210: 637–648.

14.

Haas

C.E.

LeBlanc

J.M.

Acute postoperative hypertension: a review of therapeutic options. Am J Health Syst Pharm. 2004; 61: 1661–1675.

15.

Oates

J.A.

Brown

N.J.

Antihypertensive agents and the drug therapy of hypertension. In: Hardman

J.G.

Limbird

L.E.

, eds. Goodman & Gillman's The Pharmacologic Basis of Therapeutics. 10th ed. New York: McGraw-Hill; 2001: 871–900.

16.

Nitropress (sodium nitroprusside) [product information]. Lake Forest, IL: Hospira, Inc; December 2004.

17.

Friederich

J.A.

Butterworth

J.F.

Sodium nitroprusside: twenty years and counting. Anesth Analg. 1995; 81: 152–162.

18.

Cardene IV (nicardipine) [product information]. Bedminster, NJ: EKR Therapeutics, Inc; May 2008.

19.

Halpern

N.A.

Goldberg

Neely

Postoperative hypertension: a multicenter, prospective, randomized comparison between intravenous nicardipine and sodium nitroprusside. Crit Care Med. 1992; 20: 1637–1643.

20.

van Wezel

H.B.

Koolen

J.J.

Visser

C.A.

Antihypertensive and anti-ischemic effects of nicardipine and nitroprusside in patients undergoing coronary artery bypass grafting. Am J Cardiol. 1989; 64: 22H–27H.

21.

van Wezel

H.B.

Koolen

J.J.

Visser

C.A.

The efficacy of nicardipine and nitroprusside in preventing poststernotomy hypertension. J Cardiothorac Anesth. 1989; 3: 700–706.

22.

David

Dubois

Loria

Comparison of nicardipine and sodium nitroprusside in the treatment of praroxysmal hypertension following aortocoronary bypass surgery. J Cardiothorac Vasc Anesth. 1991; 5: 357–361.

23.

Combes

Durrand

Comparison of nicardipine and sodium nitroprusside in the treatment of hypertension after coronary bypass surgery (a pilot study). Acta Anaesthesiol Belg. 1992; 43: 113–119.

24.

Kwak

Y.L.

Y.J.

Bang

S.O.

Lee

J.H.

Jeong

S.M.

Hong

Y.W.

Comparison of the effects of nicardipine and sodium nitroprusside for control of increased blood pressure after coronary artery bypass graft surgery. J Int Med Res. 2004; 32: 342–350.

25.

Aronson

Dyke

C.M.

Stierer

K.A.

The ECLIPSE trials: comparative studies of clevidipine to nitroglycerin, sodium nitroprusside, and nicardipine for acute hypertension treatment in cardiac surgery patients. Anesth Analg. 2008; 107: 1110–1121.

26.

Dorman

Thompson

D.A.

Breslow

M.J.

Lipsett

P.A.

Rosenfeld

B.A.

Nicardipine versus nitroprusside for break-through hypertension following carotid andarterectomy. J Clin Anesth. 2001; 13: 16–19.

27.

Roitberg

B.Z.

Hardman

Urbaniak

Prospective randomized comparison of safety and efficacy of nicardipine and nitroprusside drip for control of hypertension in the neurosurgical intensive care unit. Neurosurgery. 2008; 63: 115–120.

28.

Suri

M.F.

Vazquez

Ezzeddine

M.A.

Qureshi

A.I.

A multicenter comparison of outcomes associated with intravenous nitroprusside and nicardipine treatment among patients with intracerebral hemorrhage. Neurocrit Care. 2009; 11: 50–55.

29.

Lin

B.Y.

Chao

T.H.

Yao

How can activity-based costing methodology be performed as a powerful tool to calculate costs and secure appropriate patient care?

J Med Syst. 2007; 31: 85–90.

30.

Meurer

Mortality Risk Adjustment Methodology for University Health System's Clinical Data Base. In: Mortality Measurement. February 2009. Rockville, MD: Agency for Healthcare Research and Quality, http://www.ahrq.gov/qual/mortality/Meurer.htm. Assessed November 17, 2010.

31.

3M Health Information Systems. All Patient Refined Diagnosis Related Groups: Definition Manual. Wallingford, CT: Author; 2005: 993.

32.

Shahian

D.M.

Edwards

F.H.

The Society of Thoracic Surgeons 2008 cardiac surgery risk models: introduction. Ann Thorac Surg. 2009; 88: S1.

33.

Neutel

J.M.

Smith

D.H.

Wallin

A comparison of intravenous nicardipine and sodium nitroprusside in the immediate treatment of severe hypertension. Am J Hypertens. 1994; 7: 623–628.

Nicardipine versus Sodium Nitroprusside for Postcardiac Surgery Hypertension: An Evaluation of Effectiveness and Postoperative Costs

Abstract

Background

Objective

Methods

Results

Conclusions

Keywords

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References