Abstract
Hypertension is a commonly encountered condition by anesthesiologists yet there is no clearly defined approach to monitoring and managing blood pressure in the perioperative period. In this review, we focus on common dilemmas in perioperative management of hypertensive patients including preoperative evaluation and indications for postponement of elective procedures; appraise the commonly used modes of perioperative blood pressure monitoring; discuss acute hypertension in the postoperative period and the role of blood pressure in discharge criteria for patients in the post-anesthesia care unit; and we review the relevant pathophysiology of organ perfusion in chronic hypertension and the implication for postoperative blood pressure management in hypertensive patients.
Highlights
Significant discrepancy in systemic blood pressure measurements between oscillometric cuff and arterial line is a commonly encountered scenario in the perioperative period
Patients with chronic hypertension should undergo a preoperative evaluation before any nonemergent elective surgery
When NIBP and IBP measurements differ significantly in the postoperative period despite troubleshooting potential sources of error inherent to each modality, we suggest NIBP should generally be the preferred monitor for clinical decision making
Summary
Significant discrepancy in systemic blood pressure measurements between oscillometric cuff and arterial line is a commonly encountered scenario in the perioperative period. There is no consensus strategy on how to best deal with such discrepancies and management is typically based on individual clinical judgement. We will explore some of the important clinical ramifications of this predicament and suggest rationale for how to proceed in this situation
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