Should a Moratorium be Placed on Sublingual Nifedipine Capsules For Hypertensive Emergencies and Pesudoemregencies
JAMA 276:16, p 1328.
[ no abstract available ]

This article is important because it suggests that a common practice in the PACU and in the cardiovascular rooms - i.e. giving sublingual nifedipine - is neither efficacious nor safe.

It does not suggest an alternative treatment for the perioperative use of the medication - i.e. patients for whom beta blockers or other anti-hypertensive drugs may not be indicated. I would suggest that IV hydralazine, now available again after a brief discontinuation of its manufacture, is a consideration as a possibly more efficacious arterial dilator. Also, esmolol, which has very limited Beta 2 blocking activity and in the normal dose range has been shown not to significantly impact pulmonary function tests in those with pre-existing COPD, might be another alternative.

Furthermore, unlike nifedipine which has been known to precipitate myocardial infarction according to this article, perioperative beta blockers are the closest thing we have to a truly cardioprotective agent.

I know that I have changed my own practice since this JAMA article was published, and advise others to do the same. From a medico-legal point of view, it might be hard to justify its use in acute perioperative hypertension following this publication.

Return to the Current Literature Review Front Page