Anesthesia In Hypertensive Patients Research Articles

Inferior vena cava collapsibility index as a predictor of hypotension after induction of general anesthesia in hypertensive patients

BackgroundHypertensive patients are more susceptible to develop hypotension after the induction of general anesthesia (GA), most likely due to hypovolemia. An inferior vena cava collapsibility index (IVCCI) > 40–50% can predict hypotension after the induction of GA in the general population by variable accuracies. The current study aimed to investigate IVCCI% as a predictor of postinduction hypotension in hypertensive patients undergoing noncardiac surgery.MethodsUltrasound IVCCI % was assessed for all controlled hypertensive patients immediately before induction of GA. After induction of GA, patients were diagnosed with postinduction hypotension if their systolic arterial pressure (SAP) dropped by ≥ 30% of the baseline value and/or mean arterial pressure (MAP) dropped to < 65 mmHg up to 15 min after intubation. The receiver operating characteristic (ROC) curve of IVCCI% was compared to patients’ classification either developing hypotension after induction of GA or not as a gold standard.ResultsOf the 153 patients who completed the study, 62 (40.5%) developed hypotension after the induction of GA, and 91 (59.5%) did not. An IVCCI > 39% predicted the occurrence of postinduction hypotension with high accuracy (84%) (AUC 0.908, P < 0.001). The area of uncertainty (by gray zone analysis) of IVCCI lies at values from 39 to 45%. This gray zone included 21 patients (13.7% of all patients).ConclusionAn inferior vena cava collapsibility index > 39% before anesthetic induction can be a simple noninvasive reliable predictor of hypotension after the induction of GA for hypertensive patients not treated with angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) and undergoing noncardiac surgery.Trial registrationThis clinical trial was approved by the Institutional Review Board (IRB) at Zagazig University (ZUIRB #9424 dated 03/04/2022), and patients’ informed consent for participation in the study was obtained during the period from May 2022 to May 2023. All study procedures were carried out in accordance with the ethical standards of the Helsinki Declaration of 2013.

Frequency of intraoperative hypotension after the induction of anesthesia in hypertensive patients with preoperative angiotensin converting enzyme inhibitors

Objective: is to evaluate the intraoperative hypotension after anesthesia induction in controlled hypertensive patients who have been taking ACE inhibitors preoperatively.&#x0D; Methodology: Prospective study conducted at department of anesthesia and ICU Jinnah Postgraduate Medical Institute, Karachi, Pakistan from 1st march 2021 to 28th February 2022. Before the surgery, the patient's mean arterial pressure and blood pressure (systolic, diastolic) were recorded in the preoperative holding area. During the surgery, the primary anesthesia team maintained an intraoperative monitoring chart. After the surgery, patient was shifted to recovery room, patient was monitored for blood pressure, for at least 10 minutes after the shifting from operation theater.&#x0D; Results: There were 73.1% males and 26.9% females, 57.7% patients had hypotension. The mean age, BMI and duration of anesthesia of the patients was 54.07±6.85 years, 26.52±4.45 kg/m2 and 82.19±3.16 minutes, respectively. There were 74.7% patients had hypotension and on antihypertensive drugs other than ACE inhibitor and hypotension was occurred in 74.5% of patients who are using ACE inhibitors as antihypertensive drugs (p&gt;0.050).&#x0D; Conclusion: Higher incidence of intraoperative hypotension in patients with controlled hypertension who are taking ACE (Angiotensin-Converting Enzyme) inhibitors. So, controlled hypertension with ACE inhibitors is a significant risk factor for intraoperative hypotension.&#x0D; Keywords: Intraoperative hypotension, ACE inhibiotrs, Hypertensive, Anesthesia, Antihypertensive

Analysis of Hemodynamic Changes after Administration of Mepivacaine HCL 3% with Prilocaine 3% Solution + Felypressin

Introduction: With regards to the usage of local anesthetic drugs in hypertensive patients, this study is designed for comparing the effects of mepivacaine 3% and prilocaine 3% + felypressin in hemodynamic changes after inferior alveolar nerve block to help dental practitioner select anesthetic solutions for hypertensive patients considering their hemodynamic effects in order to provide patient safety.Materials &amp; Methods: In this double blind clinical trial 32 patients were referred to oral and maxillofacial surgery department of Shiraz dentistry school in 2021 were divided into 2 groups with 16 patients in each group. In first group, inferior alveolar nerve block was accomplished by mepivacaine 3% and in the other group, prilocaine 3% and felypressin. Then systolic and diastolic blood pressure, heart rate and oxygen saturation were measured at 4 different time points consisting of before injection, immediately after injection, 10 minutes after injection and 30 minutes after tooth extraction. The data were analyzed by ANOVA and T-test (p value &lt; 0.05).Results: There were no statistically significant differences in systolic blood pressure, diastolic blood pressure, heart rate and oxygen saturation changes between mepivacaine and prilocaine groups during all four sampling time points. But in each group, individually there were significant differences in systolic and diastolic blood pressure, heart rate and oxygen saturation in different times. In addition mepivacaine causes a significant increase in systolic blood pressure immediately after injection but in contrast prilocaine + felypressin didn’t do so.Conclusion: We recommend prilocaine + felypressin in comparison with mepivacaine for local anesthesia in hypertensive patients.

Study on Perioperative Management of Blood Pressure and Effects of Anaesthesia in Hypertensive Patients Undergoing General &amp; Orthopaedic Surgery

Background and Aim: During anesthesia, hypertension is the most common additional risk factor that contributes to higher mortality rate. Antihypertension medicine’s withdrawal might leads to symptoms such as anxiety, rebound hypertension, myocardial infarction, tachyarrhythmia, angina exaggeration, and sudden death. The present study aimed to assess the perioperative management of blood pressure and effects of anesthesia in hypertensive patients undergoing general and orthopedic surgery. Patients and Methods: This cross-sectional study was carried out on 162 hypertensive patients in the General Surgery and Orthopedics Units of Khyber Teaching Hospital, Peshawar for the duration from April 2022 to September 2022. Study protocol was approved by institute ethical committee. Patients aged 16 to 70 years of either gender underwent general surgery and orthopaedic surgery were enrolled. The data was acquired during the anesthetist’s initial visit to the operated hypertensive patients' 24 hour postoperative period. Antihypertensive medications, hemodynamics, anesthesia drugs, fluid use, and blood loss were main variables noted. Heart rate, systolic blood pressure, and diastolic blood pressure were Intraoperative hemodynamics. SPSS version 27 was used for data analysis. Results: Of the total 162 hypertensive patients, there were 68 (42%) male and 94 (58%) females. The overall mean age was 58.62±8.4 years. Before surgery, about 119 (73.5%) patients took antihypertensive medication whereas 124 (76.5%) had antihypertensive medication within 24 hours. The most prevalent antihypertensive medication used and most common class during postoperative management was Calcium channel Blockers and Amlodipine. The most prevalent used anesthetic drug use was Bupivacaine. The incidence of Systolic Blood Pressure (SBP) fall and rise was found in 28 and 6 patients respectively. The incidence of Diastolic Blood Pressure (DBP) fall and rise during intraoperative management was 11 and 8 patient respectively. Conclusion: The present study found that a decreased heart rate in patients who were taking beta blockers consistently. Those who took diuretics had greater DBP and HR at the completion of the procedure. There was no significant change in hemodynamic parameters with any other antihypertensive treatment. Keywords: Hypertension, General Surgery, Orthopaedic, Hemodynamics

COMPARATIVE STUDY OF HAEMODYNAMIC RESPONSE WITH LARYNGOSCOPIC ENDOTRACHEAL INTUBATION AND LARYNGEAL MASK AIRWAY INSERTION IN ADULT HYPERTENSIVE PATIENTS

INTRODUCTION: Laryngoscopy and endotracheal intubation has been the mainstay in providing adequate airway management, delivering general anaesthesia but are associated with hypertension, tachycardia and arrhythmias. These haemodynamic responses may be more hazardous in hypertensive patients. OBJECTIVE: In this study, we aimed to compare the haemodynamic response elicited by laryngoscopic endotracheal intubation with laryngeal mask airway insertion, in ASA II of adult hypertensive patients. METHODS: The study conducted on 100 hypertensive patients of either sex aged between 20 and 60 years belonging to ASA II grade and scheduled for elective surgery. The patients were randomly divided into two groups of 50 patients each. In one group (Group I) laryngoscopic endotracheal intubation was done and in another group (Group II) laryngeal mask airway was inserted. Baseline vitals of the patients (SBP, DBP, MAP, HR, SpO2) were documented. Patients were given inj. Midazolam 2mg IM and Phenargan 25 mg IM as premedication before the elective surgery. General anaesthesia was administered. Haemodynamics including heart rate, blood pressure and SpO2 were recorded every minute till intubation or insertion and at 1,3,5 minutes after intubation or insertion and then every 5 minutes till 20 minutes. RESULTS: All the haemodynamic responses (SBP,DBP,MAP,HR) in Laryngoscopy + Endotracheal Intubation Group compared to the Laryngeal Mask Airway Insertion Group was statistically signicant as the p value is &lt;0.05. CONCLUSION: The laryngeal mask airway may be used for airway management during anaesthesia in hypertensive patients on treatment in whom the pressor response would be deleterious.

Effect of anesthesia induction on cerebral tissue oxygen saturation in hypertensive patients: an observational study

ObjectiveIn hypertensive patients, the autoregulation curve shifts rightward, making these patients more sensitive than normotensive individuals to hypotension. Hypotension following the induction of anesthesia has been studied in normotensive patients to determine its effects on brain tissue oxygenation, but not enough studies have examined the effect of hypotension on brain oxygenation in hypertensive patients. The current study aimed to use near-infrared spectroscopy to evaluate brain tissue oxygen saturation after the induction of anesthesia in hypertensive patients, who may have impaired brain tissue oxygen saturation. MethodsThe study included a total of 200 patients aged > 18 years old with ASA I–III. Measurements were taken while the patient was breathing room air, after the induction of anesthesia, when the lash reflex had disappeared following the induction of anesthesia, after intubation, and in the 5th, 10th, and 15th minutes of surgery. The patients were divided into nonhypertensive and hypertensive groups. ResultsThere was a significant difference in age between the groups (p = 0.000). No correlation was found between cerebral tissue oxygen saturation and age (r = 0.015, p = 0.596). Anesthesia induction was observed to decrease mean arterial blood pressure in both groups (p = 0.000). Given these changes, there was no significant difference in brain tissue oxygen saturation between the nonhypertensive and hypertensive groups (p > 0.05). ConclusionThere was no difference between hypertensive and normotensive groups in terms of the change rates in cSO2 values. However, there was a difference between the groups in terms of cSO2 values.

Frequency of Intraoperative Hypotension After the Induction of Anesthesia in Hypertensive Patients with Preoperative Angiotensin-converting Enzyme Inhibitors.

IntroductionThe renin-angiotensin-aldosterone system (RAAS) is an important target in the treatment of hypertension. Angiotensin-converting enzyme (ACE) inhibitors block the conversion of angiotensin I to angiotensin II. ACE inhibitors not only treat hypertension but also decrease morbidity and mortality in heart failure patients and in patients with acute myocardial infarction. The discontinuation of ACE inhibitors before the surgery is still controversial. To assess the current magnitude of the problem in our population, we aimed to conduct this study, which evaluated the frequency of intraoperative hypotension after the induction of anesthesia in controlled hypertensive patients with preoperative ACE inhibitors.Material and methodsThis descriptive case series study was conducted at a tertiary hospital in a developing country after approval from the Ethics Review Committee. A total of 115 adult patients, from 16 to 60 years of age, who have undergone elective surgery, have controlled hypertension on the desired drugs for at least six months, have no history of any cardiac event, and have taken the drug on the morning of the surgery, were included in the study after written consent. The demographic data of the patients were entered into the proforma. Preoperative systolic, diastolic, and mean arterial pressure were recorded by the researcher or an assignee in the preoperative holding area. The patients were followed in the recovery room by the team conducting the study until 10 minutes after the arrival of the patient in the recovery room. All statistical analyses were performed using Statistical Packages for the Social Sciences version 19 (SPSS Inc., Chicago, IL). p-value ≤0.05 was considered significant.ResultsOf the 115 patients, 56 (48.7%) patients were in the age group between 51 and 60 years of age; 38 patients were between the ages of 41 and 50 years and only 21 patients were 40 years or less. On gender, 68 patients were female and 47 were male. According to body mass index (BMI), the majority of the patients were in the overweight group, amounting to 53 (46%), and 86 (74.78%) patients were known diabetics. Overall, 77 (66.96%) of the patients developed intraoperative hypotension with 41 (35.65%) patients requiring the use of vasopressors in order to correct the hypotension. No statistically significant difference was found between demographic and clinical variables.ConclusionIntraoperative hypotension is more frequent in patients with controlled hypertension on ACE inhibitors although more studies need to be conducted on a larger population in order to determine a more definitive result.

Evaluation of Transcranial Doppler Vasoconstrictor Vasoreactivity During General Anesthesia in Hypertensive Patients

Evaluation of Transcranial Doppler Vasoconstrictor Vasoreactivity During General Anesthesia in Hypertensive Patients

Cross-sectional study about perioperative management of Blood Pressure and effects of anaesthesia in hypertensive patients undergoing general & orthopaedic surgery

IntroductionHypertension is regarded as an additional risk factor during anaesthesia. There is not enough Indian evidence in literature regarding antihypertensive usage and its implications during perioperative period in patients undergoing general & orthopedic surgery. This drove us to conduct this study.MethodsSingle centre cross-sectional observational study conducted in a General Surgery and Orthopaedics wards of a Tertiary care hospital. The data was collected from the period of first visit by the anaesthetist to 24 h’ postoperative period of the operated hypertensive patients. The variables accounted were of antihypertensive medications, anaesthesia drugs, hemodynamics, blood loss and fluids used. The data was analysed by using descriptive statistics, nonparametric tests and P < 0.05 was considered as significant.Results180 patients had median age of 65 years (Interquartile range – 20). Calcium channel Blockers were the most common class and Amlodipine was most common antihypertensive medication used during perioperative period. 132 patients took antihypertensive medication on the morning of the surgery. In 136 patients’ antihypertensive medication was started within 24 h’ postoperative period. Bupivacaine was most common anaesthetic drug used. Intraoperative fall in SBP (Systolic Blood Pressure) was found in 31 patients, and rises were found in 7 patients. Also, intraoperative fall in DBP (Diastolic Blood Pressure) was found in 13 patients, and rises were found in 9 patients. Intraoperative hemodynamic changes were managed appropriately by the anaesthetist. The median IV fluids given intraoperatively was 1375 ml (Interquartile range – 700). Median blood loss was 272 ml (Interquartile range – 250).ConclusionAntihypertensive medications use during perioperative period were not associated with major hemodynamic changes.

Non Specific S-T Segment Variations during Intravenous Induction in Anesthesia in Hypertensive Patients Treated with Renin Angiotensin System Antagonists

Non Specific S-T Segment Variations during Intravenous Induction in Anesthesia in Hypertensive Patients Treated with Renin Angiotensin System Antagonists

Clonidine as vasoconstrictor with lignocaine for intraoral anaesthesia in patients with hypertension

Background: Local block anaesthesia achieved with an adrenaline containing solution can lead to an increase in plasma adrenaline with significant and non-significant cardiovascular changes. Clinical studies have suggested that clonidine might have haemodynamic advantages over adrenaline as a vasoconstrictor because of its central hypotensive effect. Objectives: The objectives of this study is to evaluate the efficacy of clonidine as vasoconstrictor, to check any changes in haemodynamic parameters and also to find out the onset, duration, intensity of local anaesthesia. Methods: Study included 280 patients of ASA II group, aged 40–70 years, for extraction of mandibular teeth. Patients received 2 mL of 2% lidocaine with clonidine in concentration of 15 mg/mL. Systolic blood pressure, diastolic blood pressure, mean arterial pressure, heart rate, were recorded before, during, 5 min after administration of anaesthesia, during extraction, and 10 min after extraction. Findings: One way repeated measure analysis of variance was done using SPSS Vs 20. There is a significant difference in the haemodynamic parameters during different duration of anaesthesia. Conclusion: Clonidine when used with lignocaine as vasoconstrictor for intraoral anaesthesia in hypertensive patients brought about a reduction in the blood pressure retaining all the properties of lignocaine.

Heart rate variability as a predictor of hypotension after spinal anesthesia in hypertensive patients

BackgroundHypotension is a common phenomenon after spinal anesthesia in hypertensive patients. We investigated whether heart rate variability could predict the occurrence of hypotension after spinal anesthesia in hypertensive patients.MethodsForty-one patients undergoing spinal anesthesia were included. Heart rate variability was measured at five different time points such as before fluid loading (baseline), after fluid loading as well as 5 min, 15 min and 30 min after spinal anesthesia. Fluid loading was performed using 5 ml/kg of a crystalloid solution. Baseline total power and low to high frequency ratio (LF/HF) in predicting hypotension after spinal anesthesia were analyzed by calculating the area under the receiver operating characteristic curves (AUC).ResultsModerate hypotension, defined as a decrease of mean arterial pressure to below 20-30% of the baseline, occurred in 13 patients and severe hypotension, defined as a decrease of mean arterial pressure greater than 30% below the baseline, occurred in 7 patients. LF/HF ratiosand total powers did not significantly change after spinal anesthesia. AUCs of LF/HF ratio for predicting moderate hypotension was 0.685 (P = 0.074), severe hypotension was 0.579 (P = 0.560) and moderate or severe hypotension was 0.652 (P = 0.101), respectively. AUCs of total power for predicting moderate hypotension was 0.571 (P = 0.490), severe hypotension was 0.672 (P = 0.351) and moderate or severe hypotension was 0.509 (P = 0.924), respectively.ConclusionsHeart rate variability is not a reliable predictor of hypotension after spinal block in hypertensive patients whose sympathetic activity is already depressed.

General Anesthesia in Hypertensive Patients: Impact of Pulse ressure but not Cardiac Diastolic Dysfunction on IntraoperativeHemodynamic Instability

In hypertensive patients undergoing general anesthesia, elevated pulse pressure (PP) (>60 mmHg) and/or diastolic dysfunction (DD) could be risk factors for intraoperative hemodynamic instability. The aim of this observational study was to investigate the contribution of DD and preoperative PP with the occurrence of intraoperative hemodynamic instability. Hypertensive (n=61) and normotensive (n=21) patients were scheduled to undergo urologic surgery under general anesthesia. DD was graded according to preoperative Doppler echocardiography, and preoperative brachial PP was calculated during anesthetic consultation. Episodes of hypertension and hypotension were recorded during the intraoperative period. For statistical analysis, hypertensive patients were divided into groups according to the presence or not of DD. The relationship between PP and hemodynamic instability index was assessed using multiple regression analysis. Sixty-three percent of hypertensive subjects had a PP > 60 mmHg. Among hypertensives, 30 (49%) had no DD, 19 (31%) had a mild DD and 12 (20%) had a moderate or severe DD. By comparison with controls, hemodynamic instability was significantly higher in hypertensives. Hypertensive patients with and without DD had similar hemodynamic instability index. This index was positively correlated with PP, even after adjustment on age, body mass index and mean arterial pressure (r = 0.56; p < 0.0001). The study provides evidence that increased intraoperative hemodynamic instability during general anesthesia in urologic hypertensive subjects is associated with increased preoperative brachial PP. DD does not contribute to intraoperative hemodynamic instability.

Abnormal Cardiac Autonomic Activity and Complexity in Newly Diagnosed and Untreated Hypertensive Patients after General Anesthesia

To investigate change of cardiac autonomic activity and cardiac complexity during general anesthesia in hypertensive patients, we analyzed electrocardiographic (ECG) data using power spectral analysis and approximate entropy (ApEn). Anesthesia was performed by a mixture of enflurane and nitrous oxide. From 10 minutes before induction of anesthesia

Changes of Heart Rate Variability during Anesthesia in Hypertensive Patients by Nonlinear Dynamics

Changes of Heart Rate Variability during Anesthesia in Hypertensive Patients by Nonlinear Dynamics

Mechanisms of hypotension induced by anaesthesia in hypertensive patients chronically treated with angiotensin-converting enzyme inhibitors

Mechanisms of hypotension induced by anaesthesia in hypertensive patients chronically treated with angiotensin-converting enzyme inhibitors

Anaesthesia in hypertensive patients, particular clinical aspects

Anaesthesia in hypertensive patients, particular clinical aspects

THE RESPONSES TO ANAESTHESIA OF NON-HYPERTENSIVE PATIENTS PRETREATED WITH RESERPINE

Five normotensive adult patients were given large doses of reserpine for prolonged periods of time before corrective cardiac operations. They were anaesthetized with nitrous oxide and oxygen, supplemented by either halothane or pethidine and suxamethonium. No patient showed evidence of a significant alteration in heart rate or blood pressure with induction or during the maintenance of anaesthesia for a period of 4 to 6 hours. These clinical observations, when related to previous experimental findings, suggest that the hypotension and bradycardia, which sometimes complicate anaesthesia in hypertensive patients receiving reserpine, are related to their underlying cardiovascular disease rather than to the effects of reserpine.

Use of epinephrine with local anesthesia in hypertensive patients IV. Effect of tooth extraction on blood pressure and pulse rate

Use of epinephrine with local anesthesia in hypertensive patients IV. Effect of tooth extraction on blood pressure and pulse rate

Use of epinephrine with local anesthesia in hypertensive patients III. Effect of epinephrine on blood pressure and pulse rate

In the first report,1 it was shown that the systolic, diastolic, mean and pulse pres­ sures of the dental patient in the waiting room are significantly higher than those obtained under basal conditions. In a second report,2 it was demonstrated that only the systolic, mean and pulse pres­ sures of the hypertensive patient in the waiting room could be reduced signifi­ cantly in 45 minutes by the oral adminis­ tration of 1^2 grains of secobarbital. It is the aim of this third report to continue the study of the dental patient as he moves along through the dental expe­ rience by now investigating the effects of the injection of local anesthetic with and without epinephrine. T he question might be raised why lidocaine hydrochloride and epinephrine were used as the local anesthetic solution and vasoconstrictor in this study. It should be recalled that this experiment was set up in such a fashion as to simu­ late the procedure followed in the aver­ age dental practitioner’s office.1 In keep­ ing with this policy, a survey was con­ ducted to learn what the average dental practitioner administers to a patient when local anesthesia is indicated and a vaso­ constrictor desirable. The survey showed that the agents employed in this study are used widely in dental practice. Thus, in order to m aintain the philosophy of the experiment as in the past,1’ 2 it was felt that lidocaine hydrochloride and epi­ nephrine should be used. In this m an­ ner, it was hoped to continue to “relive” the general office procedure and thus to be able to tell the practitioner not what to do but what he has been doing in terms of local anesthesia. In order to appreciate fully the rami­ fications of this problem, it is necessary to understand the effects of lidocaine hy­ drochloride and epinephrine on blood pressure and pulse rate.