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Coronary and systemic hemodynamic effects of clevidipine, an ultra-short-acting calcium antagonist, for treatment of hypertension after coronary artery surgery.
Acta Anaesthesiol Scand. 2000 Feb; 44(2):186-93.AA

Abstract

BACKGROUND

The aim was to evaluate the use of clevidipine, a new vascular selective, ultra-short-acting calcium antagonist for blood pressure control after coronary artery bypass grafting (CABG).

METHODS

The effects of clevidipine on central hemodynamics, myocardial blood flow and metabolism were studied at two different phases after CABG. In phase 1 (n=13), the hypertensive phase, the effects of clevidipine were compared to those of sodium nitroprusside (SNP) when used to control postoperative hypertension. In phase 2 (n=9), the normotensive phase, a clevidipine dose-response relationship was established.

RESULTS

At a target mean arterial pressure (MAP) of 75 mmHg, systemic vascular resistance (SVR) and heart rate (HR) were lower, preload, stroke volume (SV) and pulmonary vascular resistance (PVR) were higher, while there were no differences in myocardial lactate metabolism or oxygen extraction with clevidipine compared to SNP. In the normotensive phase, clevidipine induced a dose-dependent decrease in MAP (-19%), SVR (-27%) and PVR (-15%), accompanied by an increase in SV (10%), but no reflex increase in HR or changes in cardiac preload. Clevidipine caused a direct coronary vasodilation, as indicated by a decrease in myocardial oxygen extraction from 54% to 45%. Myocardial lactate metabolism was unaffected by clevidipine. The blood clearance of clevidipine was 0.05 l x min(-1) x kg(-1), the volume of distribution at steady state was 0.08 l x kg(-1) and the initial and terminal half-lives were <1 min and 4 min, respectively.

CONCLUSIONS

Clevidipine rapidly reduced MAP and induced a systemic, pulmonary and coronary vasodilation with no effect on venous capacitance vessels or HR. Clevidipine caused no adverse effects on myocardial lactate metabolism. Clevidipine thus appears suitable to control blood pressure after CABG.

Authors+Show Affiliations

Kieler-Jensen N
Department of Anaesthesia and Intensive Care, Sahlgrenska University Hospital, Göteborg, Sweden.
Jolin-Mellgård A
No affiliation info available
Nordlander M
No affiliation info available
Ricksten SE
No affiliation info available

MeSH

Antihypertensive AgentsCalcium Channel BlockersCoronary Artery BypassCoronary CirculationDose-Response Relationship, DrugHemodynamicsHumansHypertensionMyocardiumNitroprussidePostoperative ComplicationsPyridines

Pub Type(s)

Journal Article

Language

eng

PubMed ID

10695913

Citation

Kieler-Jensen, N, et al. "Coronary and Systemic Hemodynamic Effects of Clevidipine, an Ultra-short-acting Calcium Antagonist, for Treatment of Hypertension After Coronary Artery Surgery." Acta Anaesthesiologica Scandinavica, vol. 44, no. 2, 2000, pp. 186-93.
Kieler-Jensen N, Jolin-Mellgård A, Nordlander M, et al. Coronary and systemic hemodynamic effects of clevidipine, an ultra-short-acting calcium antagonist, for treatment of hypertension after coronary artery surgery. Acta Anaesthesiol Scand. 2000;44(2):186-93.
Kieler-Jensen, N., Jolin-Mellgård, A., Nordlander, M., & Ricksten, S. E. (2000). Coronary and systemic hemodynamic effects of clevidipine, an ultra-short-acting calcium antagonist, for treatment of hypertension after coronary artery surgery. Acta Anaesthesiologica Scandinavica, 44(2), 186-93.
Kieler-Jensen N, et al. Coronary and Systemic Hemodynamic Effects of Clevidipine, an Ultra-short-acting Calcium Antagonist, for Treatment of Hypertension After Coronary Artery Surgery. Acta Anaesthesiol Scand. 2000;44(2):186-93. PubMed PMID: 10695913.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Coronary and systemic hemodynamic effects of clevidipine, an ultra-short-acting calcium antagonist, for treatment of hypertension after coronary artery surgery. AU - Kieler-Jensen,N, AU - Jolin-Mellgård,A, AU - Nordlander,M, AU - Ricksten,S E, PY - 2000/3/1/pubmed PY - 2000/3/11/medline PY - 2000/3/1/entrez SP - 186 EP - 93 JF - Acta anaesthesiologica Scandinavica JO - Acta Anaesthesiol Scand VL - 44 IS - 2 N2 - BACKGROUND: The aim was to evaluate the use of clevidipine, a new vascular selective, ultra-short-acting calcium antagonist for blood pressure control after coronary artery bypass grafting (CABG). METHODS: The effects of clevidipine on central hemodynamics, myocardial blood flow and metabolism were studied at two different phases after CABG. In phase 1 (n=13), the hypertensive phase, the effects of clevidipine were compared to those of sodium nitroprusside (SNP) when used to control postoperative hypertension. In phase 2 (n=9), the normotensive phase, a clevidipine dose-response relationship was established. RESULTS: At a target mean arterial pressure (MAP) of 75 mmHg, systemic vascular resistance (SVR) and heart rate (HR) were lower, preload, stroke volume (SV) and pulmonary vascular resistance (PVR) were higher, while there were no differences in myocardial lactate metabolism or oxygen extraction with clevidipine compared to SNP. In the normotensive phase, clevidipine induced a dose-dependent decrease in MAP (-19%), SVR (-27%) and PVR (-15%), accompanied by an increase in SV (10%), but no reflex increase in HR or changes in cardiac preload. Clevidipine caused a direct coronary vasodilation, as indicated by a decrease in myocardial oxygen extraction from 54% to 45%. Myocardial lactate metabolism was unaffected by clevidipine. The blood clearance of clevidipine was 0.05 l x min(-1) x kg(-1), the volume of distribution at steady state was 0.08 l x kg(-1) and the initial and terminal half-lives were <1 min and 4 min, respectively. CONCLUSIONS: Clevidipine rapidly reduced MAP and induced a systemic, pulmonary and coronary vasodilation with no effect on venous capacitance vessels or HR. Clevidipine caused no adverse effects on myocardial lactate metabolism. Clevidipine thus appears suitable to control blood pressure after CABG. SN - 0001-5172 UR - https://www.unboundmedicine.com/medline/citation/10695913/Coronary_and_systemic_hemodynamic_effects_of_clevidipine_an_ultra_short_acting_calcium_antagonist_for_treatment_of_hypertension_after_coronary_artery_surgery_ DB - PRIME DP - Unbound Medicine ER -