Hypertension and anesthesia.

Department of Anesthesiology, Teikyo University School of Medicine, Itabashi-ku, Tokyo, Japan.
Current Opinion in Anaesthesiology (Impact Factor: 2.4). 07/2006; 19(3):315-9. DOI: 10.1097/
Source: PubMed

ABSTRACT There are still many controversies about perioperative management of hypertensive patients. This review aims to provide relevant instruction based on evidence regarding the treatment of those patients.
Mild to moderate hypertension is not independently responsible for perioperative cardiac complications. The position is less clear for severely hypertensive patients. A randomized study shows no benefit of the traditional practice of delaying elective surgery in severely hypertensive patients until better control of blood pressure is achieved. Perioperative use of beta-blockers or alpha-2 agonists has been shown to maintain perioperative hemodynamic stability and thereby to prevent major cardiac complications.
Delaying surgery only for the purpose of blood pressure control may not be necessary, especially in the case of mild to moderate hypertension. Strict care, however, should be taken to ensure perioperative hemodynamic stability because labile hemodynamics, rather than preoperative hypertension per se, appears to be more closely associated with adverse cardiovascular complications. Delaying surgery in hypertensive patients may be justified if target organ damage exists that can be improved by such a delay or if (suspected) target organ damage should be evaluated further before the operation.

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    ABSTRACT: Supraventricular tachyarrhythmia (including atrial fibrillation), hypertension and tachycardia in the perioperative setting, and acute ischaemic heart disease are generally agreed to require rapid attention and treatment. Prolonged tachyarrhythmia or hypertension can result in significant morbidity, such as cerebrovascular events, myocardial infarction and other end-organ damage. This article reviews the clinical efficacy and tolerability of intravenous infusions of esmolol for the short-term treatment of tachyarrhythmias and the short-term control of tachycardia and hypertension, and provides an overview of the pharmacological properties of the drug. Esmolol, a cardioselective β-blocker, has been proven effective in the control of elevated haemodynamic parameters in patients with supraventricular tachyarrhythmia, hypertension and tachycardia in the perioperative setting, and acute ischaemic heart disease, as well as being associated with a reduced risk of some clinical sequelae to increased haemodynamic parameters. Esmolol is, moreover, generally well tolerated; while it is associated with an increased risk of hypotension, this is rapidly reversible. Definitive conclusions on the efficacy of esmolol are difficult to reach, as most trials investigating esmolol have limitations such as small patient populations, and few studies investigate the same parameters. Ideally, several further studies would be beneficial; however, as esmolol is a well established, older drug, these are less likely to occur. Despite this, esmolol, as a fast-acting, rapidly reversible, easily titratable β-blocker, is an established option for the short-term treatment of tachyarrhythmias and the short-term control of tachycardia and hypertension.
    Drugs 01/2012; 72(1):109-32. · 4.13 Impact Factor
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    ABSTRACT: Perioperative blood pressure management is a key factor of patient care for anesthetists, as perioperative hemodynamic instability is associated with cardiovascular complications. Hypertension is an independent predictive factor of cardiac adverse events in noncardiac surgery. Intraoperative hypotension is one of the most encountered factors associated with death related to anesthesia. In the preoperative setting, the majority of antihypertensive medications should be continued until surgery. Only renin-angiotensin system antagonists may be stopped. Hypertension, especially in the case of mild to moderate hypertension, is not a cause for delaying surgery. During the intraoperative period, anesthesia leads to hypotension. Hypotension episodes should be promptly treated by intravenous vasopressors, and according to their etiology. In the postoperative setting, hypertension predominates. Continuation of antihypertensive medications and postoperative care may be insufficient. In these cases, intravenous antihypertensive treatments are used to control blood pressure elevation.
    Integrated Blood Pressure Control 01/2014; 7:49-59.

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