Nicardipine infusion for intraoperative hypertension control in three dogs undergoing adrenalectomy for pheochromocytoma.

Nicardipine CRI may attenuate intraoperative hypertensive episodes during canine pheochromocytoma adrenalectomy.

This case series describes the use of nicardipine, a dihydropyridine calcium channel blocker, as a constant rate infusion (CRI) to manage severe intraoperative hypertension in three dogs undergoing adrenalectomy for histopathologically confirmed pheochromocytoma. Pheochromocytomas are catecholamine-secreting adrenal tumors that frequently cause life-threatening hypertensive crises during surgical manipulation, representing a significant anesthetic challenge. In all three cases, nicardipine was initiated following a hypertensive event defined as systolic arterial pressure (SAP) exceeding 160 mmHg, using a loading dose of 20 μg/kg over 10 minutes followed by a CRI at 40 μg/kg/hour. Results varied across cases: peak SAP was reduced in Case 1, episode duration was shortened in Case 2, and SAP remained below the 160 mmHg threshold in Case 3 despite marked sinus tachycardia (heart rate >200 bpm). While nicardipine did not completely abolish hypertensive episodes in all cases, it consistently attenuated their magnitude and duration. Importantly, nicardipine caused minimal myocardial depression, consistent with its known pharmacologic profile. All three dogs recovered uneventfully and were discharged within 3–5 days postoperatively. The authors propose nicardipine CRI as a viable adjunct in managing intraoperative hypertension during canine adrenalectomy for pheochromocytoma, while acknowledging the need for further prospective studies to establish optimal dosing and integration into multimodal antihypertensive protocols.

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