on table hypertension

[kalpesh shah]

many time we come accross the situation where pt is previously non hypertensive and just before the surgery blood pressure is out of control........

what should be the strategy for it practically..????????? ???

[jafo1964]

PRE-Op
Not a known HT
Did he receive any drugs that could increase BP
If not it must be anxiety
Can try a small dose of IV Midazolam
Usually you can take them up. Once under anaesthesia they settle down well
Books say that for elective surgery BP > 190 / 110 needs to be postponed

INTRA_OP HT
Check ETCO2 - if high
change soda lime
make sure unidirectional valves are working
If using any Mapleson circuits make sure FGF is adequate

Check analgesia - give a top up of analgeics that you are using

Check plane of  anaesthesia - Dial in some more inhalational if necessary
Check relxation  - Top up of relaxant if necessary

Check drugs given - can anything produce a rise in BP

After clearing all this
reconfirm he is not a hypertensive ( need to avoid overreduction of MAP in hypertensives)


Check heart rate

if > 70 give beta blockers
Metoprolol or Esmolol
Stop when HR < 70


IF BP still high - Switch to vasodilators - inhalational or intravenous

res

[kalpesh shah]

thank you for to the point reply......

[Dr. Mian]

preop High blood pressure without h/o HTN not uncommon: in my experience usually due to undiagnosed HTN or preop anxiety; after that less common causes of secondary HTN need to be looked at (these include drugs like NSAID's although I don't know any drugs causing acute HTN other than of course pressors)

Intraop high BP is much less common in my experience (with adequate anesthesia/analgesia) and I think would have to lead to consideration of causes of 2ndary HTN.  One situation I have seen which is sometimes associated with intraop HTN with seemingly adequate anesthesia is with use of tourniquets (when it is especially troublesome) although this resolves easily with antiHTN's

[yogenbhatt1]

Dr. Jafo's replies are always to the point.
There is a note of a perfect teacher ( and a bad examiner may be???)
But class one in my opinion.
How ever, I will summerise in one line.
Hypertension in surgery? Give more anaesthesia, main cause is pain and pain, but do keep CO2 in mind.

[dhanvantri]

i am a new member of this forum and find the site very useful and interesting.i must at first thank all the members for sharing their experiences and giving suggestions without any restrictions. i am quite young to this field and have lots of questions to be answered .this forum will be very helpful to me.

sir,for administering NTG,i follow a simple calculation . one ampule -25 mg,in 500 ml of dextose gives 50 mcg per ml.so start with 10 drops per minute and adjust depending on response.the iv sets we use is generally 1ml=20 drops.
sir ,i would like to know a simple calculation for esmolol infusion.

[vk]

Re: dose calculation during infusion

I practice a simple universal formula for syringe infusion pump.  X mg in 50ml= X/3 micro gm/min if going @ 1ml/hr
Thus 400mg dopa in 50ml> 400/3=133 mics/min when flow set at 1ml/hr. One can use it with any drug, any combination; keep 50 ml syringe and 1ml/hr fixed in mind.