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Seminars in Cardiothoracic and Vascular Anesthesia, Vol. 2, No. 3, 231-242 (1998)
DOI: 10.1177/108925329800200306

Calcium Antagonists for Perioperative Blood Pressure Control

Margareta Nordlander, PhD

Department of Cardiovascular Pharmacology, Preclinical R & D, Astra Hässle AB, Mölndal, Sweden

Martin Pfaffendorf, PhD

and the Department of Pharmacotherapy, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands

Harry B. van Wezel, MD, PhD

Department of Anesthesia, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands

Calcium entry blockers constitute three major classes of pharmacologic agents: phenylalkylamines (eg, verapa mil), benzothiazepines (eg, diltiazem), and dihydropyri dines (eg, nifedipine). The effectiveness of all types of calcium channel blockers in the prevention and treat ment of coronary artery disease as well as chronic and acute hypertension is undisputable. Their beneficial clinical effects may be due to peripheral and coronary vasodilatation, resulting in reduction in myocardial oxy gen consumption, and an increase in myocardial oxy gen supply in addition to their antispasmodic effect and the ability to prevent intracellular calcium overload. For the management of perioperative hypertension develop ing in patients undergoing cardiac or noncardiac sur gery, the dihydropyridines appear to be especially suit able. Intravenous (IV) formulations of nifedipine, nicardipine, and isradipine have been successfully used in this setting. At the present time, nicardipine is the most widely used IV dihydropyridine. This is due to its potent afterload-reducing activity and relatively short duration of action, although its effect may increase the longer the drug is being infused. The ideal drug for perioperative blood pressure control should be one with the pharmacodynamic profile of the vascular selec tive dihydropyridines, but with an ultrashort duration of action.


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