Postoperative Hypertension: Novel Opportunities in the Treatment of a Common Complication

Sansone, Pasquale; Pace, Maria Caterina; Passavanti, Maria Beatrice

doi:10.4172/2167-1095.1000202

Cited by 3 publications

(5 citation statements)

References 14 publications

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“…By this definition, postoperative hypertension is associated with myocardial ischemia, infarction, arrhythmias, congestive heart failure with resulting pulmonary edema, stroke, and bleeding. [10][11][12][13][14] In patients recovering from cardiac surgery, it is common to start antihypertensive treatment when MAP reaches 105 mm Hg. 11,13 We chose MAP values of 110 and 130 mm Hg as thresholds for hypertension and severe hypertension, and again to avoid shortlived artifacts, we required episodes to last at least 30 min.…”

Section: Discussionmentioning

confidence: 99%

Incidence, Severity, and Detection of Blood Pressure Perturbations after Abdominal Surgery

et al. 2019

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Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New Background Intraoperative and postoperative hypotension are associated with myocardial and kidney injury and 30-day mortality. Intraoperative blood pressure is measured frequently, but blood pressure on surgical wards is usually measured only every 4 to 6 h, leaving long intervals during which hypotension and hypertension may be undetected. This study evaluated the incidence and severity of postoperative hypotension and hypertension in adults recovering from abdominal surgery and the extent to which serious perturbations were missed by routine vital-sign assessments. Methods Blood pressure was recorded at 1-min intervals during the initial 48 h in adults recovering from abdominal surgery using a continuous noninvasive monitor. Caregivers were blinded to these measurements and depended on routine vital-sign assessments. Hypotension and hypertension were characterized as time under and above various mean arterial pressure thresholds. Results Of 502 available patients, 312 patients with high-quality records were analyzed, with a median measurement time of 48 [interquartile range: 41, 48] postoperative hours. Nearly a quarter experienced an episode of mean arterial pressure of less than 70 mm Hg lasting at least 30 min (24%; 95% CI, 20%, 29%), and 18% had an episode of mean arterial pressure of less than 65 mm Hg lasting at least 15 min. Nearly half the patients who had mean arterial pressure of less than 65 mm Hg for at least 15 min (47%; 95% CI, 34%, 61%) were undetected by routine vital-sign assessments. Episodes of mean arterial pressure greater than 110 mm Hg lasting at least 30 min were observed in 42% (95% CI, 37%, 48%) of patients; 7% had mean arterial pressure greater than 130 mm Hg for at least 30 min, 96% of which were missed by routine assessments. Episodes of mean arterial pressure less than 65 mm Hg and mean arterial pressure greater than 110 mm Hg captured by routine vital-sign assessments but not by continuous monitoring occurred in 34 and 8 patients, respectively. Conclusions Postoperative hypotension and hypertension were common, prolonged, profound, and largely undetected by routine vital-sign assessments in a cohort of adults recovering from abdominal surgery. Frequent or continuous blood pressure monitoring may detect hemodynamic perturbations more effectively and potentially facilitate treatment.

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Section: Discussionmentioning

confidence: 99%

Incidence, Severity, and Detection of Blood Pressure Perturbations after Abdominal Surgery

et al. 2019

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“…Despite the widespread and longstanding recognition of acute postoperative hypertension (APH), there is no consensus on a more precise, quantitative definition [32]. Some authors define APH as systolic BP > 190 mmHg with or without diastolic BP ≥ 100 mmHg in at least two consecutive measurements postoperatively [33], while others recommend treatment threshold for APH as BP > 160/90 mmHg or greater than 20% elevation from preoperative baseline BP [32]. APH can begin to manifest in the first 20 minutes postoperatively and lasts on average 3-4 hours [33].…”

Section: Recommendations For Postoperative Hypertension In Patients Recovering In the Post-anesthesia Care Unitmentioning

confidence: 99%

“…Some authors define APH as systolic BP > 190 mmHg with or without diastolic BP ≥ 100 mmHg in at least two consecutive measurements postoperatively [33], while others recommend treatment threshold for APH as BP > 160/90 mmHg or greater than 20% elevation from preoperative baseline BP [32]. APH can begin to manifest in the first 20 minutes postoperatively and lasts on average 3-4 hours [33]. These patients often have a history of chronic hypertension, and the postoperative hypertension is usually transient in nature.…”

Section: Recommendations For Postoperative Hypertension In Patients Recovering In the Post-anesthesia Care Unitmentioning

confidence: 99%

Postoperative Hypertension: When Blood Pressure Cuff and Arterial Line Disagree

Storozh¹,

Ashraf²,

Smeltz³

2019

J Clin Anesth Pain Manag

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“…β-Адреноблокатор эсмолол удобен для купирования ПАГ у кардиохирургических больных благодаря высокой управляемости его действием. Он обладает быстрым (в течение 60-120 с) и непродолжительным (10-20 мин) эффектом, может использоваться в виде непрерывной инфузии [14,15]. Препарат можно применять при заболеваниях печени или почек.…”

Section: таблица 2 динамика ад и чсс в первые послеоперационные суткиunclassified

“…Он метаболизируется печенью и имеет продолжительность действия до 4 ч, поэтому препарат применяют в виде непрерывной инфузии. Болюсные инъекции 1-2 мг/кг могут приводить к резко-му снижению АД [14,15]. Лабеталол не должен использоваться у пациентов с синусовой брадикардией, бронхиальной астмой и нарушениями ритма сердца [21].…”

Section: таблица 2 динамика ад и чсс в первые послеоперационные суткиunclassified

The effectiveness of proxodolol in postoperative arterial hypertension management in cardiac surgery patients

Еременко¹,

Sorokina²,

Kurochkina³

2018

Kardiol. serdechno-sosud. khir.

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Послеоперационная артериальная гипертензия (ПАГ), возникающая у пациентов в отделении интенсивной терапии, представляет собой серьезную проблему, которая может приводить к различным, в том числе фатальным осложнениям. В исследовании ECLIPSE было продемонстрировано, что степень подъема артериального давления (АД) и продолжительность послеоперационной гипертензии у кардиохирургических больных тесно связаны с уров-нем госпитальной смертности [1]. Исследование EURO-Stat, проведенное в 2011 г., в которое вошли 790 пациентов после различных хирургических вмешательств, показало, что в среднем ПАГ встречалась у 29% больных, причем у 59% из них в анамнезе имелась гипертоническая болезнь. Наиболее часто данное осложнение (с частотой до 40%) отмечается после кардиохирургических вмешательств, тогда как остальные 60% распределяются между операциями на

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Postoperative Hypertension: Novel Opportunities in the Treatment of a Common Complication

Cited by 3 publications

References 14 publications

Incidence, Severity, and Detection of Blood Pressure Perturbations after Abdominal Surgery

Incidence, Severity, and Detection of Blood Pressure Perturbations after Abdominal Surgery

Postoperative Hypertension: When Blood Pressure Cuff and Arterial Line Disagree

The effectiveness of proxodolol in postoperative arterial hypertension management in cardiac surgery patients

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