A comparative study between a calcium channel blocker (nicardipine) and a combined alpha-beta-blocker (labetalol) for the control of emergence hypertension during craniotomy for tumor surgery

We compared the efficacy of the combination of enalaprilat/labetalol with t hat of enalaprilat/nicardipine to prevent emergence postcraniotomy hyperten sion. A prospective, randomized open labeled clinical trial was designed to compare the incidence of breakthrough hypertension (systolic blood pressur e [SBP] > 140 mm Hg) and adverse effects (hypotension, tachycardia, and bra dycardia) between the two drug combinations. Secondarily, the effects of th e drugs on SBP, mean blood pressure, and diastolic blood pressure were eval uated over the course of the study. Forty-two patients received enalaprilat 1.25 mg IV at dural closure followed by either multidose nicardipine 2 mg IV or labetalol 5 mg IV to maintain the SBP below 140 mm Hg. SBP was simila rly controlled in both groups. There was a marginally smaller incidence of failures and adverse effects with labetalol. Blood pressure profiles were s imilar for both groups.