Uyanık derin beyin stimülasyonu ameliyatında intraoperatif kan basıncı kontrolü için nikardipin ve esmololün karşılaştırılması: retrospektif bir çalışma

Abstract

Amaç: Uyanık derin beyin stimülasyonu (DBS) cerrahisi, elektrotların optimal yerleştirilmesi için hastanın bilinçli kalmasını ve intraoperatif nörofizyolojik monitörizasyona olanak tanınmasını gerektirir. Ancak, cerrahi sırasında gelişen hipertansiyon önemli klinik zorluklara neden olabilir; bu durum cerrahi doğruluğu ve hasta güvenliğini tehlikeye atabilir. İntraoperatif kan basıncı kontrolü için nikardipin ve esmolol sıklıkla kullanılmaktadır, ancak uyanık DBS cerrahisinde bu ilaçların karşılaştırmalı etkinliği net değildir. Bu çalışmanın amacı, monitörize anestezi bakımı (MAB) altında uyanık DBS cerrahisi sırasında intraoperatif kan basıncını kontrol etmede nikardipin ve esmololün etkinliğini karşılaştırmaktır. Gereç ve Yöntemler: Bu retrospektif çalışmada, Ocak 2020 ile Nisan 2025 tarihleri arasında MAB altında uyanık DBS cerrahisi geçiren hastalar değerlendirildi. İntraoperatif hipertansiyon (sistolik arter basıncı [SAP] ≥150 mmHg) gelişen 40 erişkin hasta çalışmaya dahil edildi ve uygulanan antihipertansif ajana göre iki gruba ayrıldı: nikardipin (n = 20) ve esmolol (n = 20). Hemodinamik parametreler, antihipertansif gereksinimler ve intraoperatif komplikasyonlar karşılaştırıldı. Bulgular: İntraoperatif ortalama SAP, nikardipin grubunda esmolol grubuna göre anlamlı şekilde daha düşüktü (121,9 ± 2,6 mmHg vs. 127,9 ± 3,5 mmHg, p = 0,04). Hipertansif atak sıklığı nikardipin grubunda daha düşük olmasına rağmen istatistiksel olarak anlamlı değildi (15,9% ± 3,6 vs. 26,1% ± 4,1, p = 0,21). Esmolol, anlamlı şekilde daha düşük kalp hızına neden oldu (69,2 ± 2,8 atım/dk vs. 87,9 ± 2,0 atım/dk, p = 0,01), ancak daha yüksek dozda kurtarıcı antihipertansif (gliseril trinitrat: 53,1 ± 5,8 mg vs. 25,8 ± 1,2 mg, p < 0,001) gereksinimi oldu. Her iki grupta da büyük intraoperatif komplikasyon veya genel anesteziye geçiş gözlenmedi. Sonuç: Uyanık DBS cerrahisinde, nikardipin esmollole kıyasla daha etkili ve stabil bir intraoperatif kan basıncı kontrolü sağlamış ve ek antihipertansif ilaç ihtiyacını azaltmıştır. Her iki ajan da hasta iş birliğini veya nörofizyolojik monitörizasyonu bozacak bir yan etki göstermeksizin güvenle uygulanabilmiştir. Bu nedenle, ek antihipertansif tedavi gereksiniminin daha az olması nedeniyle nikardipin tercih edilebilir.

Keywords

• uyanık derin beyin stimülasyonu
• hipertansiyon
• nikardipin
• esmollol
• intraoperatif hemodinami
• nöroanestezi

Comparison of nicardipine and esmolol for intraoperative blood pressure control during awake deep brain stimulation surgery: a retrospective study

Abstract

Aim: Awake deep brain stimulation (DBS) surgery requires the patient to remain conscious for optimal electrode placement through intraoperative neurophysiological monitoring. However, hypertension during awake DBS poses significant clinical challenges, potentially compromising surgical accuracy and patient safety. Nicardipine and esmolol are both used for intraoperative blood pressure control, but their comparative efficacy in awake DBS remains unclear. The aim of this study was to compare the effectiveness of nicardipine and esmolol in controlling intraoperative blood pressure during awake DBS surgery under monitored anesthesia care. Material and Methods: This retrospective study evaluated patients who underwent awake DBS surgery under MAC between January 2020 and April 2025. Forty adult patients experiencing intraoperative hypertension (systolic arterial pressure [SAP] ≥150 mmHg) were included and divided into two groups based on the antihypertensive agent administered: nicardipine (n = 20) or esmolol (n = 20). Hemodynamic parameters, antihypertensive requirements, and intraoperative complications were compared between the groups. Results: Mean intraoperative SAP was significantly lower in the nicardipine group compared to the esmolol group (121.9 ± 2.6 mmHg vs. 127.9 ± 3.5 mmHg, p = 0.04). Although the frequency of hypertensive episodes tended to be lower with nicardipine, this did not reach statistical significance (15.9% ± 3.6 vs. 26.1% ± 4.1, p = 0.21). Esmolol resulted in significantly lower heart rates (69.2 ± 2.8 bpm vs. 87.9 ± 2.0 bpm, p = 0.01) but required higher doses of rescue antihypertensives (glyceryl trinitrate: 53.1 ± 5.8 mg vs. 25.8 ± 1.2 mg, p < 0.001). No major intraoperative complications or conversions to general anesthesia occurred in both groups. Conclusions: Nicardipine provided more effective and stable intraoperative blood pressure control than esmolol during awake DBS surgery, reducing the need for additional antihypertensive medications. Both agents were safely administered without compromising patient cooperation or neurophysiological monitoring. Therefore, nicardipine may be preferable due to the less need for rescue antihypertensive treatment.

Keywords

• awake deep brain stimulation
• hypertension
• nicardipine
• esmolol
• intraoperative hemodynamics
• neuroanesthesia

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