I had a patient the other night with an aortic dissection. Looks like the procedure is to put the pt on both nicardapine and esmolol at the same time. Esmolol to mostly bring down the heart rate but will also bring down the bp and nicardapine to bring down the bp.
This combination terrified me ! I asked the er doctor and the icu resident both and they said yes to start them at the same time. I was terrified that the pts bp would bottom out. Her initial bp was around 154/72 and the goal was systolic of 100-120 with hr in the 60s
So I talked to the icu resident told them I was not comfortable starting them together. Eventually we started the esmolol first and then when I maxed out the esmolol I started the nicardapine.
I found the esmolol dropped the pressure a little to 130-140 systolic and would not drop it any more so eventually I did start the nicardapine at 5mg/hr while esmolol was dripping at the max rate and it brought the pressure down into the 120s systolic. Then we transferred pt to icu
So question is how would you have handled these two drips together?
