Hemodynamic Effects of Intravenous Bolus Dosing of Nicardipine on Pneumoperitoneum during Laparoscopically-Assisted Vaginal Hysterectomy (LAVH)

Yoon, Hea Jo; Jee, Young Suck

Abstract

BACKGROUND: Pneumoperitoneum and a head-down tilt during a laparoscopically-assisted vaginal hysterectomy (LAVH) decrease the cardiac index with a concurrent increase in blood pressure. This study investigated the effects of bolus nicardipine on the changes in the hemodynamics.
METHODS
The patients scheduled for LAVH were randomly assigned to 1 of 3 treatment groups: control (n = 40) receiving normal saline; NIC 15 (n = 40) and NIC 30 (n = 40) groups receiving intravenous nicardipine 15 microgram/kg, 30 microgram/kg, respectively 1min before pneumoperitoneum. The hemodynamic parameters (mean blood pressure [MBP], cardiac index [CI], and heart rate [HR]) were measured before inducing anesthesia (INI, only the MBP and HR [the CI was not measured]), immediately after tracheal intubation (INT), prior to the skin incision (BF), and 2, 5, 10, 20, and 30 min after pneumoperitoneum (P2, P5, P10, P20, P30) by noninvasive cardiac output measurements. A p value < 0.05 was considered statistically significant.
RESULTS
In the control group, the MBP increased significantly 5min after pneumoperitoneum compared with the INI. There was a decrease in the MBP in the NIC 30 group at P2, P5 compared with the INI, but there was no reduction of MBP at INI > 20%. In the control group, the CI had decreased at P2, P5 in comparison with BF. An increase of CI was observed at P5 in the NIC 15 group and at P2, 5, and 10 in the NIC 30 group compared with the control group.
CONCLUSIONS
Intravenous bolus dosing of 30 microgram/kg nicardipine at 1 min before pneumoperitoneum during LAVH can reduce the decrease in CI after pneumoperitoneum and Trendelenburg position in LAVH but the blood pressure needs to be monitored carefully.