Management Of Perioperative Hypertension Research Articles

Perioperative hypertension

The effects of hypertension on the outcomes during the perioperative period are still unclear. No specific systolic or diastolic blood pressure measurement has been determined as the cutoff point to continue with the surgical plan or adjourn.This study is designed as a narrative review of the available scientific evidence on the perioperative management of hypertension. A non-systematic review was conducted in Pubmed considering the title and abstract; 120 articles were pre-selected of which 55 papers were selected for full-text eligibility and 16 were excluded for a total of 39 articles including ACCF/AHA 2009 and ACC/AHA 2014 on perioperative cardiovascular care; 2013 ESH/ESC, 8 JNC, and the 2017 ACC/AHA/AAPA/ABC Guideline for the Prevention, detection, and management of hypertension in adults. Blood pressure values, target organ damage, and type of surgery should be considered for decision-making in the perioperative period. If surgery is an option, blood pressure fluctuations should be avoided and actively treat any potential causes. A patient with mild hypertension with values below SBP 160 and DBP 110 mmHg may be managed in the ambulatory setting during the postoperative period, as long as the clinical conditions are favorable.

A Cross-Sectional Survey of Practice Patterns Among Mohs Micrographic Surgeons in the Assessment and Management of Perioperative Hypertension.

A Cross-Sectional Survey of Practice Patterns Among Mohs Micrographic Surgeons in the Assessment and Management of Perioperative Hypertension.

Perioperative management of hypertension

Hypertension has a very high prevalence, affecting 46% of the population in the US; it is a major culprit for adverse cardiovascular outcomes, renal disease and stroke; it also carries a substantial impact in the perioperative period. It is frequently encountered in the perioperative time, and its presence can potentially affect the hemodynamic control during anesthesia. Intraoperatively, hypotension may be present associated with anesthesia; however hypertension may predominate postoperatively. The presence of uncontrolled hypertension preoperatively may lead to cancellation of surgical procedures with consequent adverse impact in multiple domains (psychological, social and financial) for patients and their families, as well as operational for the healthcare system. There is paucity of data providing guidance on ideal blood pressure values for elective anesthesia and surgery. We consider a reasonable goal to aim for a systolic pressure 140 mmHg or less and diastolic pressure 90 or less preoperatively. In patients with systolic pressure of 180 mmHg or higher or diastolic pressure of 110 mmHg or higher, we recommend postponing the surgery until achieving a better blood pressure control, given the associated increased risk for adverse perioperative cardiovascular outcomes. Most antihypertensive medications need to be continued perioperatively. We have reviewed the recommendations on perioperative management of different antihypertensive medications.

Anesthetic management for palliative arterial switch operation

Objective To summarize the anesthetic management experience for palliative arterial switch operation (PASO). Methods Twenty-eight patients who suffered from transposition of the great arteries(TGA) with septal ventricular defect (TGA/VSD) or Taussing-Bing syndrome underwent PASO were reviewed. The median age was 4 y (ranging from 1 month to 25 y) and the median body weight was 12.5 kg(ranging from 3.6 kg to 43 kg). ALL of them were diagnosed with severe pulmonary hypertension preoperatively. Their preoperative SpO2 was fluctuated from 44% to 91%. Results All anesthetic procedures went smoothly. The mean CPB time was (223± 81) min and the mean cross-clamp time was (153±32) min. The mean size of fenestration in VSD patch was (5.3±1.5) mm. The median postoperative mechanical ventilation time and stay length in intensive care unit was 36 h (ranging from 7 h to 408 h) and 5.5 d (ranging from 2 d to 27 d), respectively. The mean postoperative SpO2 increased significantly to 96% (P<0.05). The mortality rate was 18%. The fenestrations in 5 patients were closed interventionally during 1-5 y after hospital discharge. Conclusions The success of PASO depends on adequate preoperative assessment and preparation, stabel anesthesia induction, management of perioperative pulmonary hypertension and the early and rational administration of cardiovascular drugs, and the adjustment of hemostatic function. Key words: Transposition of the great arteries; Palliative arterial switch operation; Anesthetic management

Safety and Efficacy of Intravenous Clevidipine for the Perioperative Control of Acute Hypertension

Clevidipine is a third generation dihydropyridine calcium channel blocker recently approved by the Food and Drug Administration and is an emerging option for management of perioperative hypertension. This intravenous medication has several properties that may be advantageous when rapid and safe blood pressure control is required, including fast onset, short duration of action and the lack of renal or hepatic metabolism. Clevidipine has been demonstrated to be safe and efficacious for the management of perioperative hypertension in the cardiac surgery population, with minimal excursions outside of the target blood pressure range. Despite the fact that clevidipine does have certain advantages over alternative agents, it has some distinct limitations associated with its use, including higher associated costs and limited data in non-cardiac surgery patients. While clevidipine may serve as an additional option, further research is required to fully establish the role of clevidipine in the management of perioperative hypertension.

Perioperative hypertension management.

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 difficult. 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.

Calcium Antagonists for Perioperative Blood Pressure Control

Calcium entry blockers constitute three major classes of pharmacologic agents: phenylalkylamines (eg, verapa mil), benzothiazepines (eg, diltiazem), and dihydropyri dines (eg, nifedipine). The effectiveness of all types of calcium channel blockers in the prevention and treat ment of coronary artery disease as well as chronic and acute hypertension is undisputable. Their beneficial clinical effects may be due to peripheral and coronary vasodilatation, resulting in reduction in myocardial oxy gen consumption, and an increase in myocardial oxy gen supply in addition to their antispasmodic effect and the ability to prevent intracellular calcium overload. For the management of perioperative hypertension develop ing in patients undergoing cardiac or noncardiac sur gery, the dihydropyridines appear to be especially suit able. Intravenous (IV) formulations of nifedipine, nicardipine, and isradipine have been successfully used in this setting. At the present time, nicardipine is the most widely used IV dihydropyridine. This is due to its potent afterload-reducing activity and relatively short duration of action, although its effect may increase the longer the drug is being infused. The ideal drug for perioperative blood pressure control should be one with the pharmacodynamic profile of the vascular selec tive dihydropyridines, but with an ultrashort duration of action.

Perioperative management of hypertension and tachycardia

Perioperative management of hypertension and tachycardia