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خرید پکیج

تعداد آیتم قابل مشاهده باقیمانده : 3 مورد

Drugs used to lower blood pressure in the operating room: Adult dosing*^¶

Drugs used to lower blood pressure in the operating room: Adult dosing*^¶

Drug	Functional class (predominant receptor or mechanism)	Bolus dose	Infusion dose	Comments
Beta blocking agents – Generally avoided in patients with acute decompensated heart failure
Esmolol	Beta₁-selective adrenergic receptor blockade	10 to 50 mg, which may be repeated (every 5 to 15 minutes depending upon the initial dose used, the desired effect, and the patient's risk for hemodynamic decompensation)	50 to 300 mcg/kg/minute	Rapid onset and very short duration of action Clearance is not dependent on renal or hepatic function due to rapid metabolism by plasma esterases
Metoprolol	Beta₁-selective adrenergic receptor blockade	1 to 5 mg, followed by 2.5 to 15 mg every 3 to 6 hours	N/A	Commonly used agent to treat suspected myocardial ischemia due to tachycardia with normal or elevated blood pressure
Labetalol	Blockade of postsynaptic alpha₁-adrenergic receptors and non-selective beta blockade for beta₁- and beta₂-adrenergic receptors	Initial bolus of 5 to 25 mg, which may be followed by repeated boluses every 10 minutes (up to 300 mg)	0.5 to 2 mg/minute up to a maximum of 10 mg/minute (generally reserved for hypertensive emergencies)	Often selected as a first-line agent to treat concomitant hypertension and tachycardia Use cautiously in patients with obstructive or reactive airway disease Avoid in hyperadrenergic states (eg, pheochromocytoma or cocaine or methamphetamine overdose) since beta blockade and loss of beta₂-mediated vasodilation induced by labetalol can lead to severe hypertension when prior alpha₁-adrenergic blockade is incomplete
Calcium channel blocking agents – Use cautiously in patients with increased ICP
Nicardipine*	Selective dihydropyridine-type calcium channel blocker; selective arteriolar smooth muscle relaxation	100 to 500 mcg	5 to 15 mg/hour	Predominantly arteriolar vasodilator Commonly used for neurosurgical patients
Clevidipine	Selective dihydropyridine-type calcium channel blocker; selective arteriolar smooth muscle relaxation	N/A	Initial dose 1 to 2 mg/hour, with rapid titration up to 16 mg/hour	Rapid onset and short duration of action Clearance is not dependent on renal or hepatic function due to rapid metabolism by plasma esterases
Direct vasodilators (direct relaxation of vascular smooth muscle) – Generally avoided in patients with increased ICP
Hydralazine	Highly selective vasodilation of arterial resistance vessels	Initial bolus of 2.5 mg followed by repeated boluses every 5 minutes to a maximum 20 mg	N/A	Minimal or no effect on the venous circulation Relatively slow onset compared with other antihypertensive agents
Nitroglycerin (glyceryl trinitrate)	Nitrodilator that causes increased release of NO, resulting in smooth muscle relaxation	10 to 40 mcg, which may be repeated and/or followed by infusion	10 to 200 mcg/minute or 0.1 to 3 mcg/kg/minute	Continuous monitoring using an intra-arterial catheter is warranted as soon as feasible, particularly if higher doses are used SL or paste forms of nitroglycerin paste (1 to 2 inches) formulations also available
Nitroprusside	Nitrodilator that directly releases NO, resulting in smooth muscle relaxation	N/A	10 to 200 mcg/minute or 0.1 to 3 mcg/kg/minute	Continuous monitoring using an intra-arterial catheter is necessary Cyanide accumulation may occur
Other antihypertensive agents
Fenoldopam	Selective agonist for D₁ dopamine receptors; binds with moderate affinity to alpha₂-adrenoceptors	N/A	Initial dose at 0.1 mcg/kg/minute titrated up to a maximum of 1.6 mcg/kg/minute	Rarely used in perioperative settings Generally avoided in patients with glaucoma or increased ICP

N/A: not applicable; ICP: intracranial pressure; NO: nitric oxide; SL: sublingual.

* Dose ranges are based on adult patients of average size.

¶ Refer to related UpToDate content on hemodynamic management during anesthesia.

Graphic 119750 Version 2.0

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