The Effects of Nicardipine and Esmolol Applied for Controlled Hypotension
Condition: Hypotension; Surgery-Complications; Oxygen Deficiency
MeSH terms: Hypotension; Hypoxia
Study type: Interventional

Summary: 
      In this study, the effects of nicardipine and esmolol applied for controlled hypotension in
      rhinoplasty on hemodynamics and regional renal oxygenation will be investigated.
    

Detailed description: 
      The procedure to be applied to the cases to be included in the study:

      Patients randomized by the sealed envelope method will be divided into 2 groups (40 patients
      in each group).

      The sealed envelopes that determine which group the patient will belong to will be randomly
      selected by the patient.

      Standard general anesthesia will be applied to all patients. Before starting the surgical
      procedure; Group N (Nicardipine infusion) will be administered at a dose of 5-15mg/h, and
      Group E (Esmolol infusion) at a dose of 50-300mcg/kg/min.

      2) General anesthesia will be applied to all groups. Patients will be administered controlled
      hypotension (mean arterial pressure 50-60 mmHg).

      After the patients are taken to the operating table, standard electrocardiography (ECG),
      peripheral oxygen saturation (SpO2), heart rate (HR), blood pressure monitoring, and regional
      renal oxygenation will be provided with Near-infrared reflectance spectroscopy (NIRS)
      monitoring. .

      Systolic arterial pressure (SAB), diastolic arterial pressure (DAP), mean arterial pressure
      (MAP), HR, SpO2, and NIRS values will be recorded.

      3) Demographic data of the patients [age, weight, height, body mass index (BMI), smoking],
      duration of operation, need for intraoperative muscle relaxants and/or opioids, surgical
      satisfaction and intraoperative blood loss will be recorded.

      4) General anesthesia procedure: After monitoring as standard, vascular access will be opened
      with 2 pieces of 18 gauge cannula. After adequate preoxygenation, induction will be achieved
      with 2mg/kg propofol, 2/µg fentanyl and 0.6mg rocuronium. In the maintenance of anesthesia,
      40% O2, 60% medical air and 1 MAC value Desflurane inhaler will be used as anesthetic agent.
      Anesthesia puberty will be followed by BIS monitoring and BIS value will be kept between
      40-60 in all patients.

      For regional renal oxygenation, NIRS probes will be placed in both kidneys (at the level of
      the posterior axillary line, between the lumbar 6-7 range. After the initial value is
      recorded, recordings will be taken every 5 minutes throughout the operation. A 20% change in
      values will be considered significant.

      At the end of the operation, after standard decurarization, extubation will be performed when
      appropriate conditions are met. After the recovery, the Mini Mental Test will be filled in
      the patient.

      A surgical satisfaction questionnaire will be filled after the operation.
    

Intervention name(s): Controlled hypotention
Intervention type(s): Procedure
Intervention description(s): The procedure to be applied to the cases to be included in the study:
Patients randomized by the sealed envelope method will be divided into 2 groups (40 patients in each group).
The sealed envelopes that determine which group the patient will belong to will be randomly selected by the patient.
Standard general anesthesia will be applied to all patients. Before starting the surgical procedure; Group N (Nicardipine infusion) will be administered at a dose of 5-15mg/h, and Group E (Esmolol infusion) at a dose of 50-300mcg/kg/min.
2) General anesthesia will be applied to all groups. Patients will be administered controlled hypotension (mean arterial pressure 50-60 mmHg).
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: The patients included in the study will be divided into 2 groups according to the closed envelope system. Patients given esmolol infusion will be named Group E (n:40), patients given nicardipine infusion will be named Group N (n:40).
Masking: Single (Participant)
Primary purpose: Treatment
Keywords: Controlled hypotension; rhinoplasty; esmolol; nicardipine; regional renal oxygenation