Continuous infusion of nimodipine during coronary artery surgery: Haemodynamic and pharmacokinetic study

9Citations
Citations of this article
12Readers
Mendeley users who have this article in their library.

This article is free to access.

Abstract

A continuous infusion of nimodipine 15 or 30 μg kg-1 h-1 was administered from the evening before operation to the second morning after operation to 14 patients undergoing elective coronary artery bypass grafting (CABG) surgery. Nimodipine was tolerated well by ail seven patients who received the lower dose. However, of the seven patients who received the higher dose, in two patients the infusion had to be discontinued after induction of anaesthesia and immediately after surgery, respectively, because of excessive vasodilatation and hypotension. At steady state before cardiopulmonary bypass (CPB), total plasma nimodipine concentration was higher than expected on the basis of previous reports in non-surgical subjects. Similarly, mean clearance of nimodipine was lower than predicted, that is 0.53 (range 0.40-0.72) litre kg-1 h-1. Initiation of CPB decreased total plasma nimodipine concentration, but the unbound plasma concentration did not decrease because of the increase observed in the free fraction of nimodipine in plasma. As evaluated in a separate closed extracorporeal circuit, nimodipine was sequestered into the circuit. Addition of stored whole blood to the priming solution attenuated this sequestration. It is concluded that clearance of nimodipine, as assessed before CPB at steady state, was reduced in patients undergoing CABG and receiving a continuous infusion of nimodipine. Using this finding of decreased clearance in designing infusion schemes of nimodipine for cardiac surgical patients, it should be possible to predict more accurately the desired plasma nimodipine concentration and therefore reduce the possibility of unexpected haemodynamic responses.

Cite

CITATION STYLE

APA

Hynynen, M., Siltanen, T., Sahlman, A., Pohjasvaara, T., Muck, W., & Kaste, M. (1995). Continuous infusion of nimodipine during coronary artery surgery: Haemodynamic and pharmacokinetic study. British Journal of Anaesthesia, 74(5), 526–533. https://doi.org/10.1093/bja/74.5.526

Register to see more suggestions

Mendeley helps you to discover research relevant for your work.

Already have an account?

Save time finding and organizing research with Mendeley

Sign up for free