Comparative study of Esmolol, Nicardipine, and Sodium Nitroprusside in intraoperative hypertensive crises induced by pheochromocytoma.

Abstract

Management of pheochromocytoma, perioperative hemodynamic instability, and hypertensive crises calls for a customized pharmaceutical strategy. This review evaluates the safety and efficacy of esmolol, nicardipine, and sodium nitroprusside (SNP) in specific clinical contexts. Esmolol, an ultra-short-acting β-adrenergic receptor antagonist, plays a critical role in the management of tachyarrhythmias and myocardial stress, particularly in the perioperative period following pheochromocytoma resection. Its rapid onset allows for precise titration; however, continuous hemodynamic monitoring is imperative to mitigate the risk of bradycardia and hypotension. Nicardipine, a dihydropyridine calcium channel antagonist, is widely utilized for acute blood pressure control in hypertensive crises and perioperative hypertension. By reducing afterload while maintaining coronary perfusion, it serves as an effective agent in hemodynamic stabilization.

Its vascular selectivity reduces cardiac depression; hence, it is appropriate even in individuals with low ejection fraction. Although SNP, a direct nitric oxide donor, offers instantaneous and reversible vasodilation for surgical hypotension and hypertension crises, especially with continuous usage, it must be closely monitored due to concerns about cyanide and thiocyanate toxicity.

           Choosing the suitable antihypertensive treatment calls for weighing comorbidities and patient-specific hemodynamic factors. In terms of controlling heart rate, nicardipine lowers blood pressure effectively while causing minimal heart damage, and SNP is a strong emergency antihypertensive drug that raises concerns about toxicity. Knowing these agents fully maximizes clinical results in high-risk cardiovascular diseases.