Factors predicting incremental administration of antihypertensive boluses during deep brain stimulator placement for Parkinson’s disease

2.50
Hdl Handle:
http://hdl.handle.net/10757/336286
Title:
Factors predicting incremental administration of antihypertensive boluses during deep brain stimulator placement for Parkinson’s disease
Authors:
Rajan, Shobana; Deogaonkar, Milind; Kaw, Roop; Nada, Eman MS; Hernández, Adrian V. ( 0000-0002-9999-4003 ) ; Ebrahim, Zeyd; Avitsian, Rafi
Citation:
1. Rajan S, Deogaonkar M, Kaw R, Nada EM, Hernandez AV, Ebrahim Z, et al. Factors predicting incremental administration of antihypertensive boluses during deep brain stimulator placement for Parkinson’s disease. Journal of Clinical Neuroscience. octubre de 2014;21(10):1790-5.
Publisher:
Elsevier B.V.
Issue Date:
28-Nov-2014
URI:
http://hdl.handle.net/10757/336286
DOI:
10.1016/j.jocn.2014.04.005
Additional Links:
http://www.sciencedirect.com/science/article/pii/S0967586814002136
Abstract:
Hypertension is common in deep brain stimulator (DBS) placement predisposing to intracranial hemorrhage. This retrospective review evaluates factors predicting incremental antihypertensive use intraoperatively. Medical records of Parkinson’s disease (PD) patients undergoing DBS procedure between 2008–2011 were reviewed after Institutional Review Board approval. Anesthesia medication, preoperative levodopa dose, age, preoperative use of antihypertensive medications, diabetes mellitus, anxiety, motor part of the Unified Parkinson’s Disease Rating Scale score and PD duration were collected. Univariate and multivariate analysis was done between each patient characteristic and the number of antihypertensive boluses. From the 136 patients included 60 were hypertensive, of whom 32 were on angiotensin converting enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARB), told to hold on the morning of surgery. Antihypertensive medications were given to 130 patients intraoperatively. Age (relative risk [RR] 1.01; 95% confidence interval [CI] 1.00–1.02; p = 0.005), high Joint National Committee (JNC) class (p < 0.0001), diabetes mellitus (RR 1.4; 95%CI 1.2–17; p < 0.0001) and duration of PD >10 years (RR 1.2; 95%CI 1.1–1.3; p = 0.001) were independent predictors for antihypertensive use. No difference was noted in the mean dose of levodopa (p = 0.1) and levodopa equivalent dose (p = 0.4) between the low (I/II) and high severity (III/IV) JNC groups. Addition of dexmedetomidine to propofol did not influence antihypertensive boluses required (p = 0.38). Intraoperative hypertension during DBS surgery is associated with higher age group, hypertensive, diabetic patients and longer duration of PD. Withholding ACEI or ARB is an independent predictor of hypertension requiring more aggressive therapy. Levodopa withdrawal and choice of anesthetic agent is not associated with higher intraoperative antihypertensive medications.
Type:
info:eu-repo/semantics/article
Rights:
info:eu-repo/semantics/openAccess
Language:
eng
Description:
avitsir@ccf.org
Keywords:
Anesthesia; Deep brain stimulation; Dexmedetomidine; Intraoperative hypertension; Neurosurgery; Parkinson’s disease; Propofol
ISSN:
0967-5868

Full metadata record

DC FieldValue Language
dc.contributor.authorRajan, Shobanaspa
dc.contributor.authorDeogaonkar, Milindspa
dc.contributor.authorKaw, Roopspa
dc.contributor.authorNada, Eman MSspa
dc.contributor.authorHernández, Adrian V.spa
dc.contributor.authorEbrahim, Zeydspa
dc.contributor.authorAvitsian, Rafispa
dc.creatorUniversidad Peruana de Ciencias Aplicadas (UPC)spa
dc.date.accessioned2014-11-28T18:19:22Z-
dc.date.available2014-11-28T18:19:22Z-
dc.date.issued2014-11-28-
dc.identifier.citation1. Rajan S, Deogaonkar M, Kaw R, Nada EM, Hernandez AV, Ebrahim Z, et al. Factors predicting incremental administration of antihypertensive boluses during deep brain stimulator placement for Parkinson’s disease. Journal of Clinical Neuroscience. octubre de 2014;21(10):1790-5.spa
dc.identifier.issn0967-5868-
dc.identifier.doi10.1016/j.jocn.2014.04.005-
dc.identifier.urihttp://hdl.handle.net/10757/336286-
dc.descriptionavitsir@ccf.orgspa
dc.description.abstractHypertension is common in deep brain stimulator (DBS) placement predisposing to intracranial hemorrhage. This retrospective review evaluates factors predicting incremental antihypertensive use intraoperatively. Medical records of Parkinson’s disease (PD) patients undergoing DBS procedure between 2008–2011 were reviewed after Institutional Review Board approval. Anesthesia medication, preoperative levodopa dose, age, preoperative use of antihypertensive medications, diabetes mellitus, anxiety, motor part of the Unified Parkinson’s Disease Rating Scale score and PD duration were collected. Univariate and multivariate analysis was done between each patient characteristic and the number of antihypertensive boluses. From the 136 patients included 60 were hypertensive, of whom 32 were on angiotensin converting enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARB), told to hold on the morning of surgery. Antihypertensive medications were given to 130 patients intraoperatively. Age (relative risk [RR] 1.01; 95% confidence interval [CI] 1.00–1.02; p = 0.005), high Joint National Committee (JNC) class (p < 0.0001), diabetes mellitus (RR 1.4; 95%CI 1.2–17; p < 0.0001) and duration of PD >10 years (RR 1.2; 95%CI 1.1–1.3; p = 0.001) were independent predictors for antihypertensive use. No difference was noted in the mean dose of levodopa (p = 0.1) and levodopa equivalent dose (p = 0.4) between the low (I/II) and high severity (III/IV) JNC groups. Addition of dexmedetomidine to propofol did not influence antihypertensive boluses required (p = 0.38). Intraoperative hypertension during DBS surgery is associated with higher age group, hypertensive, diabetic patients and longer duration of PD. Withholding ACEI or ARB is an independent predictor of hypertension requiring more aggressive therapy. Levodopa withdrawal and choice of anesthetic agent is not associated with higher intraoperative antihypertensive medications.eng
dc.formatapplication/pdfspa
dc.language.isoengeng
dc.publisherElsevier B.V.spa
dc.relation.urlhttp://www.sciencedirect.com/science/article/pii/S0967586814002136spa
dc.rightsinfo:eu-repo/semantics/openAccessspa
dc.subjectAnesthesiaspa
dc.subjectDeep brain stimulationspa
dc.subjectDexmedetomidinespa
dc.subjectIntraoperative hypertensionspa
dc.subjectNeurosurgeryspa
dc.subjectParkinson’s diseasespa
dc.subjectPropofolspa
dc.titleFactors predicting incremental administration of antihypertensive boluses during deep brain stimulator placement for Parkinson’s diseasespa
dc.typeinfo:eu-repo/semantics/articlespa
dc.description.peer-reviewRevisión por paresspa
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