Intraoperative Hypertension

1. Intraoperative Hypertension Reader in Anaesthesiology Kanyakumari Government Medical College kumudha

2. Dr. Kumudha Lingaraj M.D. D.A Definition Hypertension: Diastolic pressure greater than 90-95 mm Hg or systolic pressure greater than 140 – 160mm Hg Borderline hypertension: Diastolic BP 85-89 mm Hg or systolic pressure of 140 – 159 mm Hg Accelerated / Severe : – Diastolic BP in excess of 110 – 115 mm Hg. Malignant hypertension: – More than 200 / 140 mm Hg, associated with papilloedema and frequently encephalopathy. kumudha

3. Hypertension Why Important ? • Common disorder • High risk factor for cardiovascular diseases • End organ damage – Heart Brain & Kidney • Alteration in cerebral & renal blood flow kumudha

4. Etiology of Intraoperative hypertension kumudha

5. Etiology of Hypertension • Intubation hypertension • Inadequate anesthesia • Hypercapnia • Hypoxemia • Pharmacological adjuvants • Phaeochromocytoma • Surgical procedures • Bladder distension • Extubation hypertension • PIH kumudha

6. Intubation hypertension • Laryngoscopy & intubation are known causes of hypertension • It is severe if laryngoscopy is prolonged • Can be minimized by pre administration of lignocaine. kumudha

7. Etiology of Hypertension • Intubation hypertension • Inadequate anesthesia • Hypercapnia • Hypoxemia • Pharmacological adjuvants kumudha

8. Inadequate anaesthesia • Stimulation during inadequate anaesthesia • The depth of anaesthesia can be monitored by BIS • Tachycardia, sweating, grimacing, tears and movement indicate inadequate anesthesia • Beware of empty vaporizers kumudha

9. Etiology of Hypertension • Intubation hypertension • Inadequate anesthesia • Hypercapnia • Hypoxemia • Pharmacological adjuvants kumudha

10. Hypercapnia • Increased sympathetic stimulation causes hypertension • Watch out for: inadequate tidal volume Depleted soda lime Disconnection of circuits Inadequate fresh gas flow • Malignant hyperthermia and thyrotoxicosis • Exogenous admn of carbondioxide during laproscopic procedures kumudha

11. Etiology of Hypertension • Intubation hypertension • Inadequate anesthesia • Hypercapnia • Hypoxemia • Pharmacological adjuvants kumudha

12. Hypoxemia • Hypoxia increases cardiac output • In severe hypoxia the systolic blood pressure is raised • Severe systolic hypertension is a very late sign of hypoxemia and indicate complete circulatory collapse. kumudha

13. Etiology of Hypertension • Intubation hypertension • Inadequate anesthesia • Hypercapnia • Hypoxemia • Pharmacological adjuvants kumudha

14. Pharmacological adjuvants • Inotropic & vasoconstrictor agents • Local anesthetic solutions containing adrenaline if injected intravenously • Nasal packing • Medication errors kumudha

15. Etiology of Hypertension • Intubation hypertension • Inadequate anesthesia • Hypercapnia • Hypoxemia • Pharmacological adjuvants • Surgical procedures kumudha

16. Surgical procedures • Aortic cross clamping • Aortic valve replacement • Carotid endarterectomy • PDA ligation kumudha

17. Management • Preanesthetic evaluation • Perioperative risk reduction • Premedication • Balanced anesthesia • Proper monitoring • Parenteral medications kumudha

18. Preanesthetic evaluation • History • Physical examination • Adequacy of blood pressure control kumudha

19. Perioperative risk reduction • Effective control of blood pressure • Anti Hypertensive drug therapy • Hydration • Choice of anesthetic agent • Adequate analgesia • Miscellaneous kumudha

22. kumudha

23. Thankyou kumudha