HYPERTENSION IN INFANTS AND CHILDREN: Anesthetic Implications

Abstract

Hypertension is recognized as a major public health problem in adults, affecting about 20% of the population of the United States. In the past, most anesthesiologists believed that the incidence of hypertension in children was rare, and most of the cases were the result of secondary renal, cardiovascular, or endocrine pathology. After the publication of the Task Force on Blood Pressure in Children in 1977, 1987, and 1996, it has become apparent that childhood hypertension is a more common problem than perceived. 91,102,131 The incidence of hypertension is 1% to 3% among children and adolescents. The stress associated with the emotional and physical insults inflicted during the perioperative period results in major swings in vital signs. They may be magnified by effects of the many drugs administered by the anesthesiologist. These changes are even more profound in the physiologically challenged hypertensive child. Therefore, the anesthesiologist should document a baseline blood pressure in any child or infant scheduled for surgery, so that he or she can make prudent decisions that do not put the patient at increased risk. This article reviews the definitions and technical aspects of blood pressure measurement in infants and children, focuses on specific causes and pathophysiology of hypertension, discusses therapeutic modalities for hypertensive emergencies, and presents practical aspects to anesthetizing hypertensive children and infants.