An analysis on the management of anesthesia effects in patients with high blood pressure undergoing general and orthopedic surgery

Hypertension is a major risk factor for causing coronary events, stroke, heart failure, peripheral arterial disease, dissecting aneurysm, chronic kidney disease, and mortality. 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. Hypertension 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. Single 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 ۲۴ 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 < ۰.۰۵ was considered as significant. ۱۸۰ patients had median age of ۶۵ years (Interquartile range – ۲۰). Calcium channel Blockers were the most common class and Amlodipine was most common antihypertensive medication used during perioperative period. ۱۳۲ patients took antihypertensive medication on the morning of the surgery. In ۱۳۶ patients’ antihypertensive medication was started within ۲۴ h’ postoperative period. Bupivacaine was most common anaesthetic drug used. Intraoperative fall in SBP (Systolic Blood Pressure) was found in ۳۱ patients, and rises were found in ۷ patients. Also, intraoperative fall in DBP (Diastolic Blood Pressure) was found in ۱۳ patients, and rises were found in ۹ patients. Intraoperative hemodynamic changes were managed appropriately by the anaesthetist. The median IV fluids given intraoperatively was ۱۳۷۵ ml (Interquartile range – ۷۰۰). Median blood loss was ۲۷۲ ml (Interquartile range – ۲۵۰). Antihypertensive medications use during perioperative period were not associated with major hemodynamic changes.

کلیدواژه ها:

hypertension ، hypertensive crises ، intraoperative ، perioperative ، postoperative.