Factors predicting incremental administration of antihypertensive boluses during deep brain stimulator placement for Parkinson’s disease
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Authors
Rajan, ShobanaDeogaonkar, Milind
Kaw, Roop
Nada, Eman MS
Hernández, Adrian V.
Ebrahim, Zeyd
Avitsian, Rafi
Issue Date
2014-11-28Keywords
AnesthesiaDeep brain stimulation
Dexmedetomidine
Intraoperative hypertension
Neurosurgery
Parkinson’s disease
Propofol
Metadata
Show full item recordCitation
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.Journal
Journal of Clinical NeuroscienceDOI
10.1016/j.jocn.2014.04.005Additional Links
http://www.sciencedirect.com/science/article/pii/S0967586814002136Abstract
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/articleRights
info:eu-repo/semantics/openAccessLanguage
engDescription
[email protected]ISSN
0967-5868ae974a485f413a2113503eed53cd6c53
10.1016/j.jocn.2014.04.005
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