The effect of nicardipine and esmolol for controlled hypotension in rinoplasty nterventions on hemodynamics and regional renal oxygenization

Objective: It was aimed to investigate the effects of nicardipine and esmolol applied for controlled hypotension in rhinoplasty procedures on hemodynamics and regional renal oxygenation. Materials and Methods: 80 patients who underwent elective rhinoplasty surgery and decided to underwent controlled hypotension, who were informed about the subject and whose written consents were obtained, between the ages of 18-60, and ASA I-II were included in the study. The patients were divided into 2 groups, Group N (Nicardipine) and Group E (Esmolol), consisting of 40 people, by the closed envelope method. In order to cause controlled hypotension, 40 patients were administered nicardipine and 40 patients were given esmolol infusion intraoperatively. During the maintenance of anesthesia, the potential for controlled hypotension of nicardipine and esmolol infusion, cardiovascular hemodynamics, renal functions and regional renal perfusion (NIRS) values were measured. The number of additional opioid and additional muscle relaxant use was recorded for both groups. Surgical satisfaction and the amount of bleeding in the surgical area were recorded postoperatively for both groups. Results: In Group N, the rate of intraoperative additional opioid use was higher than Group E (p = 0.000). Postoperative measured surgical bleeding (p = 0.000). and surgical satisfaction was significantly higher in Group N than Group E (p = 0.002). Pulse values were statistically significantly higher in Group E (p = 0.000). Systolic blood pressure (except 0.-10.-15.-20. minutes) was statistically significant in Group E (p ˂ 0.05). In the comparison between groups, postop creatinine values were found to be significantly decreased in both groups compared to preoperative values (p <0.05). However, intragroup urea and intergroup urea / creatinine values were not different (p> 0.05). All peripheral SpO2 values measured in Group N were significantly lower than Group E (p˂0.05). Left renal rSO₂ (NIRS) value was significantly higher in Group N in the intraoperative period (10.-15.-20.-25.-30.-35.-40. 45.-50.-55.minutes) compared to Group E (p ˂ 0.05). Conclusion: In controlled hypotension with esmolol, we believe that it can be used safely in cases where controlled hypotension will be applied and should be preferred primarily because of the more stable blood pressure and heart rate values compared to nicardipine, the use of less additional muscle relaxants and additional opioids, and better surgical satisfaction. Nicardipine is a better agent on regional renal tissue perfusion and has no adverse effect on renal functions. However, when used to induce controlled hypotension, the need for additional opioids increased, and hemodynamics remained labile.