Perioperative Management of Patients on Nicardipine

Preoperative Considerations

The American College of Cardiology recommends continuing calcium channel blockers, such as nicardipine, throughout the perioperative period for patients with hypertension undergoing noncardiac surgery (Class IIa, Level C-EO) 1
The American College of Cardiology and American Heart Association guidelines list nicardipine as an appropriate agent for perioperative hypertension management, indicating its safety and efficacy in the surgical setting 2
The European Society of Cardiology and European Society of Anaesthesiology recommend continuation of calcium channel blockers during noncardiac surgery, particularly in patients with vasospastic angina or those who cannot tolerate beta-blockers 3
Exercise caution when continuing antihypertensive therapy in patients with low or low-normal perioperative blood pressures, older adults (≥65 years), and patients at high risk for perioperative hypotension based on surgery type and anesthetic plan 1

The American College of Cardiology and American Heart Association guidelines recommend maintaining intraoperative mean arterial pressure ≥60-65 mm Hg or systolic blood pressure ≥90 mm Hg to reduce risk of myocardial injury (Class I, Level B-NR) 1
Nicardipine is recommended as a first-line agent for intraoperative hypertension, with a target blood pressure of <160/90 mm Hg or systolic blood pressure elevation <20% of preoperative value persisting >15 minutes 2
Nicardipine is also recommended for acute coronary syndromes, acute renal failure, and acute sympathetic discharge states during surgery 2

The American College of Cardiology and American Heart Association guidelines recommend restarting preoperative antihypertensive medications as soon as clinically reasonable to avoid complications from postoperative hypertension (Class I, Level C-EO) 1
Treatment of hypotension (MAP <60-65 or systolic blood pressure <90 mm Hg) in the postoperative period is recommended to limit risk of cardiovascular, cerebrovascular, renal events, and mortality (Class I, Level B-NR) 1

If the patient cannot take oral medications perioperatively, intravenous nicardipine is an excellent bridge therapy option, as it is water-soluble, light-stable, and can be easily titrated 4
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Since there is no other source, this fact will be kept, but it is worth noting that it is from 'Praxis Medical Insights' 4