Effect of Diltiazem and Nicardipine on Postoperative Extubation Response in Patients with Intracranial Surgery

Objective To compare the efficacy of Nicardipine and Diltiazem on the cardiovascular responses during tracheal extubation and emergence from anesthesia in patients with intracranial surgery,and their negative influence on heart function.Methods Sixty ASA Ⅰ-Ⅱ patients with intracranial space-occupying lesion undergoing elective intracranial surgery were randomly divided into 0.9% NS group(Group C),0.2 mg/kg Diltiazem group(Group D) and 15 μg/kg Nicardipine group(Group N).The drugs were used two minutes before tracheal extubation.The blood pressure(BP),heart rate(HR),stroke volume index(SVI) and cardiac index(CI) was recorded at designed time points: pre-adminstation,post-adminstation,immediate at extubation,1,3,5 and 10 min after extubation.And the rate-pressure product(RPP) was calculated.Results Compared with pre-adminstation,the maximum increase of MAP,HR and RPP in group C were 21.1%,32.8% and 52.2% associated with tracheal extubation(P0.01).The increase of MAP induced by tracheal extubation were depressed both by Nicardipine and Diltiazem(MAPmax:2.9% vs 3.6%,P0.05).The inhibitory effects of Diltiazem on HR responding to the tracheal extubation were greater than those of Nicardipine(HRmax: 12.7% vs 24.6%,P0.01).CI increased after the bolus injection of Diltiazem or Nicardipine.Conclusion Nicardipine is effective in depressing pressure response to tracheal extubation but cannot prevent the tachycardia;Diltiazem can produce a greater attenuation on the circulatory responses to tracheal extubation.