Perioperative hypertension management

Abstract

Perioperative hypertension is commonly encountered in patients that undergo surgery. While attempts have been made to standardize the method to characterize the intraoperative hemodynamics, these methods still vary widely. In addition, there is a lack of consensus concerning treatment thresholds and appropriate therapeutic targets, making absolute recommendations about treatment diffi cult. Nevertheless, perioperative hypertension requires careful management. When treatment is necessary, therapy should be individualized for the patient. This paper reviews the pharmacologic agents and strategies commonly used in the management of perioperative hypertension.

Peri-Operative Steroid Induced Hypertension- A Case Report

“…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 .…”

“…It can occur during pre-operative period, intra operatively and in the post-operative period. Post-operative hypertension has a variable incidence ranging from 4% to 30% 1 . We report a case of corticosteroid induced hypertension in the immediate postoperative period in a patient, who underwent open reduction and internal fixation (ORIF) for fracture clavicle.…”

“…All corticosteroids including prednisone can cause sodium retention, resulting in dose-related fluid retention and hypertension. Corticosteroids with strong mineral ocorticoid effects, such as fludrocortisone and hydrocortisone produce the greatest amount of fluid retention 1 . were administered before night and 6 am on the day of surgery.…”

Optimizing care for the obese patient in interventional radiology

“…In a hypertensive emergency (blood pressure >180 mmHg systolic or >110 mmHg diastolic with evidence of end organ damage), the goal is to decrease blood pressure over 30-60 min in conjunction with volume expansion with normal saline to prevent hypotension. Preferred agents include nicardipine and labetalol because they have a short onset and short duration of action, are easy to titrate, and have been shown to be safe in the treatment of perioperative hypertension (43). Hydralazine is generally not recommended in the treatment of hypertensive emergency because the half-life of its effect on blood pressure is about 10 hours and dependent on an individual patient's hepatic acetylation and inactivation (44).…”

Prevalence and distribution of hypertension among the patients presenting for surgery under anaesthesia in a tertiary care hospital in South India

“…5 So despite these potential dangers, the present recommendation for a patient with high blood pressure is to go ahead with the surgery unless the blood pressure is more than systolic 180 or diastolic 110 mmHg. 6,7 Nevertheless, many anaesthesiologists, especially those from non-Western countries, prefer to have the blood pressure under control before they proceed with the surgery. This is because most of the studies with a liberal approach to hypertension before surgery are from Western set ups where the perioperative monitoring to detect any untoward events related to hypertension is optimum and the promptness of response to any eventuality is exemplary.…”