Hypertension in the Immediate Postoperative Period

Gal, Thomas J.; Cooperman, Lee H.

doi:10.1093/bja/47.1.70

Cited by 139 publications

(40 citation statements)

References 6 publications

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“…Gal & Cooperman (1975) in Philadelphia observed it in 3% of their cases, while in Gloucester 5% of our patients had systolic pressures above 170 mmHg. There was a smaller but significant number in Cambridge.…”

Section: Cardiovascular Complicationsmentioning

confidence: 49%

“…50% of these patients had pain; other causes were underventilation, distension of the bladder, fluid overload and hypothermia. Gal & Cooperman (1975) specifically looked for other causes, but in 30% of their cases no obvious cause was found. When we had treated the obvious causes, such as pain, respiratory depression or a distended bladder, most patients reverted tp preoperative levels within 2-3 hours.…”

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confidence: 99%

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Complications in the Recovery Room

Eltringham

1979

J R Soc Med

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The complications described here are the experience of a study of over 10'000 consecutive patients at Gloucestershire Royal Hospital (Eltringham et al. 1978). Reference is also made to a similar study of 30000 patients in Cambridge (Farman 1978). Gloucestershire Royal Hospital is a district general hospital. There is no specialized surgery so the majority of patients are on routine lists. Emergency operations performed during the daytime are included, the recovery unit being closed at night.During an 18-month period, 10013 patients were admitted to the unit. More than 500 regional blocks were performed, most of them epidurals accompanied by light general anaesthesia, so that only 100 patients (1%) were actually conscious during operation. Patients remained in the recovery unit until they had regained consciousness, breathing was adequate and the cardiovascular system stable.The patients fell into three groups according to the duration of their stay in the unit. The first group (6202 patients, 62%) required little or no postoperative treatment and were all discharged in less than half an hour. The second group (3654 patients, 36.5%) required more careful monitoring, treatment or medical advice, but were ready for transfer within 2 hours. The patients in the third group (157 patients, 1.5%) had not recovered fully after 2 hours and for them the recovery unit was a short-stay ICU; 33 of them were eventually transferred to the ICU. For the purpose of simplicity, the complications are divided into cardiovascular, respiratory and others, although of course some patients had more than one complication. Cardiovascular complicationsObservations were made of blood pressure, pulse rate and regularity, and of signs of bleeding. Patients were not discharged while abnormalities were present. The commonest complication in both Cambridge and Gloucester was hypotension (systolic BP < 100 mmHg), which occurred in about 5% of patients in both series. This frequently followed induced hypotensive anaesthesia, but was also common after a normotensive general anaesthetic, accompanied by evidence of good peripheral perfusion. Once the effects of the anaesthetic had worn off the blood pressure usually returned to normal. Hypotension was seldom accompanied by signs of bleeding, but when it persisted intravenous fluids and slight head-down tilt were usually effective.Of approximately 500 patients, drug treatment was given in only 17. Hydrocortisone, atropine, ephedrine and methoxamine were used. Eight patients gave persistent cause for concern. Of these, 4 were transferred to ICU for CVP monitoring, 3 with persistent bleeding were returned to theatre, and one became progressively hypotensive and developed irreversible asystole.Hypertension seems to be a feature of most series. Gal & Cooperman (1975) in Philadelphia observed it in 3% of their cases, while in Gloucester 5% of our patients had systolic pressures above 170 mmHg. There was a smaller but significant number in Cambridge. Apart from patients who had had surgery of the aorta, and ...

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Section: Cardiovascular Complicationsmentioning

confidence: 49%

mentioning

confidence: 99%

Complications in the Recovery Room

Eltringham

1979

J R Soc Med

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“…This can occur during preoperative period due to anxiety 1,4 , during intra-operative period due to intubation response, due to pain induced by surgical stimulation and during extubation due to sympathetic response 1,4 . In the post anaesthesia period, hypertension can be associated with pain-induced sympathetic stimulation, hypothermia, hypoxia, hypercarbia, bladder distension and intravascular volume overload from excessive intraoperative intravenous fluid therapy 3 . Blood pressure can also rise due to discontinuation of blood pressure medications postoperatively.…”

Section: Discussionmentioning

confidence: 99%

“…Postoperative hypertension has been defined as SBP of above 190 mmHg and/or DBP of 100 mmHg on two consecutive readings 1 . These acute episodes occur in the first 20 minutes of the postoperative period, although its resolution can require up to 3 hours [3][4][5] . If left untreated, postoperative hypertension increases the risk of myocardial ischaemia, myocardial infarction, cerebro vascular accidents, and bleeding 6 .…”

Section: Discussionmentioning

confidence: 99%

Peri-Operative Steroid Induced Hypertension- A Case Report

Pingale¹

2017

jmscr

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“…In 60 pazienti controllati in sala di risveglio e in cui la PA era di 190/100 mmHg, le cause probabili di ipertensione sono state: dolore (36%), ipossia e ipercapnia (19%), eccitazione (32%) [25].…”

Section: Ipertensione Postoperatoriaunclassified

Perioperative hypertension

Pinna¹,

Grotta²

2013

Ital J Med

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IntroduzioneL'ipertensione perioperatoria, forse per le sue caratteristiche (frequente impossibilità della somministrazione orale, necessità di un effetto rapido ma ben modulabile, possibile presenza di squilibri idroelettrolitici ecc.), è un problema avvertito più dagli anestesisti che dagli internisti ipertensivologi. Le linee guida europee (ESH-ESC) del 2003 non citano l'ipertensione perioperatoria, mentre il settimo rapporto del Joint National Committee (JNC) [1] dedica poche righe all'argomento, per suggerire che «un'ipertensione non controllata è associata a maggiori fluttuazioni della pressione arteriosa durante l'induzione dell'anestesia e con l'intubazione e può aumentare il rischio di eventi ischemici perioperatori. Livelli di pressione arteriosa ≥ 180/110 mmHg dovrebbero essere controllati prima dell'intervento». Ammette comunque che «l'ipertensione è molto comune nel periodo postoperatorio precoce per l'aumento del tono simpatico e delle resistenze vascolari. The intraoperative arterial pressure should be maintained within 20% of the best estimated preoperative arterial pressure, especially in patients with markedly elevated preoperative pressures. After surgery the arterial BP can increase for stress factors, pain, hypoxia and hypercapnia, hypothermia and infusional liquids overload. For all these reasons a careful monitoring is mandatory. Anti-hypertensive medication should be continued during the postoperative period in patients with known and treated hypertension, as unplanned withdrawal of treatment can result in rebounded hypertension. The decision to give anti-hypertensive drugs must be made for each patient, taking into account their normal BP and their postoperative BP. With regard to the optimal treatment of the patient with poorly or uncontrolled hypertension in the perioperative evaluation, recent guidelines suggest that the best treatment may consider cardioselective β-blockers therapy, but also clonidin by transdermic way. ACE-ihinibitors and angiotensin-II-antagonists are allowed, but with caution, like as dihydropiridinic calcium-antagonists. Sublingual nifedipin is not recommended, owing to the evidence of an increased morbidity and mortality. Diuretics can lead to dangerous liquids depletions and would not be used in absence of specific indications (such as congestive heart failure, etc.). In hypertensive crisis the most used drugs remain NPS, nitrates, i.v. β-blockers (labetalol, esmolol), fenoldopam. CONCLUSIONS Postoperative BP should always be reviewed with reference to the preoperative and intraoperative assessments. KEY WORDSPerioperative hypertension Preoperative hypertension Postoperative hypertension β-Blockers

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Hypertension in the Immediate Postoperative Period

Cited by 139 publications

References 6 publications

Complications in the Recovery Room

Complications in the Recovery Room

Peri-Operative Steroid Induced Hypertension- A Case Report

Perioperative hypertension

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