1
|
Mohseni S, Behnam-Roudsari S, Tarbiat M, Shaker P, Shivaie S, Shafiee MA. Perioperative Hypertension Etiologies in Patients Undergoing Noncardiac Surgery in University Health Network Hospitals–Canada from 2015–2020. Integr Blood Press Control 2022; 15:23-32. [PMID: 35340537 PMCID: PMC8942122 DOI: 10.2147/ibpc.s347395] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 03/03/2022] [Indexed: 12/04/2022] Open
Abstract
Introduction Perioperative hypertension, defined as increased blood pressure around the surgery, is a known risk factor for perioperative complications, including cardiovascular events. Identifying reasons associated with hypertension in each period is of great help in preventing and better managing perioperative hypertension. Objective The aim of the study was to explore common etiologies of hypertension during the perioperative period (pre, intra, and post-operation) in patients who underwent noncardiac surgeries in University Health Network (UHN) hospitals, Canada, from 2015 to 2020. Patients and Methods We retrospectively analyzed the medical records of 174 patients undergoing noncardiac surgeries who experienced perioperative hypertension. We assessed the prevalence of 10 reasons for perioperative hypertension as a whole and also each period separately according to the physicians’ notes in patients’ medical records. Two-way measurements ANOVA was used to determine the change of mean hypertension among patients for specific etiology. Results The common etiologies of perioperative hypertension were poorly controlled hypertension (21.8%), excessive fluid therapy (19.5%), excessive vasopressor (18.4%), and medication withdrawal (13.7%). Regarding each period separately, the most common reasons were poorly controlled hypertension for pre (42.9%) and intraoperative period (22.7%) and fluid overload for the postoperative period (20.1%). Poor control of hypertension showed both within-subject statistical significance for systolic and between-subject statistical significance for diastolic blood pressure. Conclusion Poorly controlled hypertension is the most significant etiology of perioperative hypertension in patients undergoing noncardiac surgeries. Apart from poorly controlled hypertension, as a patient-related factor, iatrogenic factors such as excessive vasopressor therapy, aggressive fluid replacement and poor management of antihypertensive medications can also cause perioperative hypertension.
Collapse
Affiliation(s)
- Sana Mohseni
- Division of General Internal Medicine, Department of Medicine, Toronto General Hospital, Toronto, ON M2G 2C4, Canada
| | - Sahar Behnam-Roudsari
- Division of General Internal Medicine, Department of Medicine, Toronto General Hospital, Toronto, ON M2G 2C4, Canada
| | - Mohammad Tarbiat
- Division of General Internal Medicine, Department of Medicine, Toronto General Hospital, Toronto, ON M2G 2C4, Canada
| | - Pouyan Shaker
- College of Medicine, Kansas City University, Kansas City, MO, USA
| | - Seyedmohammadshahab Shivaie
- Division of General Internal Medicine, Department of Medicine, Toronto General Hospital, Toronto, ON M2G 2C4, Canada
| | - Mohammad A Shafiee
- Division of General Internal Medicine, Department of Medicine, Toronto General Hospital, Toronto, ON M2G 2C4, Canada
- Correspondence: Mohammad A Shafiee, Division of General Internal Medicine, Department of Medicine, Toronto General Hospital, 200 Elizabeth Street, 14 EN-208, Toronto, ON M5G 2C4, Canada, Tel +1 416-340-4800 ext 6244, Fax +1 416-595-5826, Email
| |
Collapse
|
2
|
Zublena F, De Gennaro C, Corletto F. Retrospective evaluation of labetalol as antihypertensive agent in dogs. BMC Vet Res 2020; 16:256. [PMID: 32709242 PMCID: PMC7378306 DOI: 10.1186/s12917-020-02475-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 07/13/2020] [Indexed: 11/25/2022] Open
Abstract
Background To evaluate the effect on arterial blood pressure (ABP) of labetalol infusion as treatment for perioperative non nociceptive acute hypertension in dogs. The clinical records of dogs receiving intra or postoperative labetalol infusion were retrospectively reviewed. Invasive systolic (SAP), mean (MAP) and diastolic (DAP) arterial pressure and heart rate (HR) before labetalol infusion (T0) and 15, 30, 45 and 60 min (T1, T2, T3 and T4 respectively) after infusion were retrieved. The dose rate of labetalol infusion and use of concurrently administered drugs that could have potentially affected ABP and/or HR were also recorded. ANOVA for repeated measures and Dunnett’s multiple comparison test were used to determine the effect of labetalol on ABP and HR. Differences were considered significant when p < 0.05. Results A total of 20 dogs met the inclusion criteria, and hypertension was documented after craniotomy (12/20), adrenalectomy (4/20) and other procedures (4/20). Five dogs received labetalol intraoperatively, 14 postoperatively, and 1 during the surgical procedure and recovery. Median infusion duration and rate were 463 (60-2120) minutes and 1.1 (0.2–3.4) mg/kg/h respectively. Median loading dose was 0.2 (0.2–0.4) mg/kg. Labetalol produced a significant decrease in SAP and DAP at all time points compared to T0 (p < 0.05), while the effect was not significant at T1 for MAP (p = 0.0519). Median maximum MAP decrease was 31 (20–90) mmHg. Heart rate did not increase significantly during treatment (p = 0.2454). Acepromazine given before or during labetalol treatment did not reduce significantly ABP (p = 0.735). Conclusions Labetalol produced a reliable and titratable decrease in ABP with non significant increase in HR.
Collapse
Affiliation(s)
- Francesco Zublena
- Department of Veterinary Anaesthesia, Dick White Referrals, Six Mile Bottom, Station Farm, London Road, Six Mile Bottom, CB8 0UH, Cambridgeshire, UK.
| | - Chiara De Gennaro
- Department of Veterinary Anaesthesia, Dick White Referrals, Six Mile Bottom, Station Farm, London Road, Six Mile Bottom, CB8 0UH, Cambridgeshire, UK
| | - Federico Corletto
- Department of Veterinary Anaesthesia, Dick White Referrals, Six Mile Bottom, Station Farm, London Road, Six Mile Bottom, CB8 0UH, Cambridgeshire, UK
| |
Collapse
|
3
|
|
4
|
Doo AR, Son JS, Han YJ, Yu HC, Ko S. Hypertensive crisis caused by electrocauterization of the adrenal gland during hepatectomy. BMC Surg 2015; 15:11. [PMID: 25972017 PMCID: PMC4429467 DOI: 10.1186/1471-2482-15-11] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Accepted: 01/06/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hypertensive crisis (i.e., systolic blood pressure over 300 mmHg) is very rare during operation except pheochromocytoma, but it can be a fatal and embarrassing to surgeons and anesthesiologists. The right adrenal gland can be electrocauterized during a right hemi-hepatectomy. We report a case of hypertensive crisis during right hemi-hepatectomy in which the right adrenal gland was stimulated by monopolar electrocautery in a patient with normal neuroendocrine function. CASE PRESENTATION A 73-year-old man with hepatocellular carcinoma was scheduled to undergo right hemi-hepatectomy. Three hours into the surgery, the patient's blood pressure increased abruptly from 100/40 to over 350/130 mmHg (the maximum measurement pressure of the monitor; 350 mmHg). The surgeon had cauterized the right adrenal gland using monopolar electrocautery to separate the liver from the adrenal gland immediately prior to the event. Approximately 3 minutes after suspending the operation, blood pressure returned to baseline levels. After the event, the operation was successfully completed without any complication. Hormonal studies and iodine-123 meta-iodobenzylguanidine scintigraphy revealed no neuroendocrine tumor such as a pheochromocytoma. CONCLUSION Operations such as hepatectomy that stimulate the adrenal gland may lead to an unexpected catecholamine surge and result in hypertensive crisis, even if neuroendocrine function of the adrenal gland is normal.
Collapse
Affiliation(s)
- A Ram Doo
- Department of Anesthesiology and Pain Medicine, Research Institute of Clinical Medicine, Chonbuk National University Medical School and Hospital, Jeonju, Republic of Korea.
| | - Ji-Seon Son
- Department of Anesthesiology and Pain Medicine, Research Institute of Clinical Medicine, Chonbuk National University Medical School and Hospital, Jeonju, Republic of Korea.
| | - Young-Jin Han
- Department of Anesthesiology and Pain Medicine, Research Institute of Clinical Medicine, Chonbuk National University Medical School and Hospital, Jeonju, Republic of Korea.
| | - Hee Chul Yu
- Department of Surgery and Research Institute of Clinical Medicine, Chonbuk National University Medical School and Hospital, Jeonju, Republic of Korea.
| | - Seonghoon Ko
- Department of Anesthesiology and Pain Medicine, Research Institute of Clinical Medicine, Chonbuk National University Medical School and Hospital, Jeonju, Republic of Korea.
| |
Collapse
|
5
|
Park SH, Lee YS, Min TJ, Kim WY, Kim JH, Park YC. Anesthetic management of hypertensive crisis in a three-year-old patient with undiagnosed severe renal artery stenosis: a case report. Korean J Anesthesiol 2014; 67:275-8. [PMID: 25368787 PMCID: PMC4216791 DOI: 10.4097/kjae.2014.67.4.275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Revised: 08/23/2013] [Accepted: 09/23/2013] [Indexed: 11/10/2022] Open
Abstract
Pediatric hypertensive crisis is a potentially life threatening medical emergency, usually secondary to an underlying disease. Hypertension commonly occurs during general anesthesia, and is usually promptly and appropriately treated by anesthesiologists. However in children with severe, unexplained, or refractory hypertension, it has the potential to cause morbidity and even mortality in susceptible patients. We report an anesthetic management of an unexpected hypertensive crisis that developed during general anesthesia in a three-year-old girl with undiagnosed severe left renal artery stenosis.
Collapse
Affiliation(s)
- Sang-hee Park
- Department of Anesthesiology and Pain Medicine, Korea University Ansan Hospital, Ansan, Korea
| | - Yoon-Sook Lee
- Department of Anesthesiology and Pain Medicine, Korea University Ansan Hospital, Ansan, Korea
| | - Too Jae Min
- Department of Anesthesiology and Pain Medicine, Korea University Ansan Hospital, Ansan, Korea
| | - Woon Young Kim
- Department of Anesthesiology and Pain Medicine, Korea University Ansan Hospital, Ansan, Korea
| | - Jae Hwan Kim
- Department of Anesthesiology and Pain Medicine, Korea University Ansan Hospital, Ansan, Korea
| | - Young Cheol Park
- Department of Anesthesiology and Pain Medicine, Korea University Ansan Hospital, Ansan, Korea
| |
Collapse
|
6
|
Kalezic N, Stojanovic M, Milicic B, Antonijevic V, Sabljak V, Markovic D, Zivaljevic V. The incidence of intraoperative hypertension and risk factors for its development during thyroid surgery. Clin Exp Hypertens 2013; 35:523-7. [PMID: 23301599 DOI: 10.3109/10641963.2012.758735] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
We studied the influence of demographic characteristics, comorbidity, and type and duration of surgery and anesthesia on the occurrence of intraoperative hypertension (IOHTA). Logistic regression analyses were used in order to determine the predictors of occurrence of IOHTA. More than 60% of our patients had IOHTA. Multivariate analysis showed that independent predictors for IOHTA were older age, BMI 25 kg/m(2), and hypertension as a coexisting disease. Hypertension is common during thyroid surgery, and a significant number of patients remained hypertensive during the postoperative period.
Collapse
Affiliation(s)
- Nevena Kalezic
- Faculty of Medicine, University of Belgrade , Belgrade , Serbia
| | | | | | | | | | | | | |
Collapse
|
7
|
Abstract
In order to review anaesthetic morbidity in our remote rural hospital, a retrospective audit of all anaesthetic records was undertaken for a five-year period between 2006 and 2010. Eight hundred and eighty-nine anaesthetic records were reviewed. The patients were all American Society of Anaesthesiologists physical status I to III. Ninety-eight percent of the anaesthetics were performed by general practitioner (non-specialist) anaesthetists. There were no anaesthetic deaths or serious adverse outcomes reported over this period. Sixteen intraoperative and seven postoperative problems were documented, but all were resolved uneventfully. The most common problems documented were difficult intubation (n=9) and respiratory depression (n=3). Within the limitations of this retrospective audit, these findings indicate that general practitioner anaesthetists provided safe anaesthesia in a remote rural hospital. It is our opinion that the case selection, prior experience of anaesthetic and theatre staff, stable nursing workforce and the use of protocols were important factors in determining the low rate of adverse events. However, we caution against over-interpretation of the data, given its retrospective nature, relatively small sample size, reliance on case records and the absence of agreed definitions for adverse events. We would also like to encourage all anaesthetic services, however remote, to audit their results as part of ongoing quality assurance.
Collapse
Affiliation(s)
- P. D. Mills
- Ceduna Hospital, Ceduna, South Australia, Australia
- Spencer Gulf Rural Health School, Adelaide
| | - J. Newbury
- Ceduna Hospital, Ceduna, South Australia, Australia
- Spencer Gulf Rural Health School, Whyalla
| |
Collapse
|
8
|
|
9
|
Carey M, Carter J, Nesbitt I. Phaeochromocytoma Crisis Presenting under Anaesthesia with Profound Left Ventricular Failure — Successful Treatment with Intra-Aortic Balloon Pump. J Intensive Care Soc 2010. [DOI: 10.1177/175114371001100311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
A patient presented with a phaeochromocytoma crisis during routine anaesthesia for minor ENT surgery. The ensuing cardiac arrest and profound left ventricular failure were successfully treated with an intra-aortic balloon pump until alpha blockade with phenoxybenzamine took effect. The rapid diagnosis of phaeochromocytoma and management of phaeochromocytoma crisis are reviewed.
Collapse
Affiliation(s)
- Michelle Carey
- Michelle Carey Consultant in Anaesthesia and Intensive Care Medicine, The James Cook University Hospital, Middlesbrough
| | - Jim Carter
- Jim Carter Consultant Anaesthetist, Freeman Hospital, Newcastle upon Tyne
| | - Ian Nesbitt
- Ian Nesbitt Consultant in Anaesthesia and Intensive Care Medicine, Freeman Hospital, Newcastle upon Tyne
| |
Collapse
|
10
|
Sierra P, Galcerán JM, Sabaté S, Martínez-Amenós A, Castaño J, Gil A. [Hypertension and anesthesia: consensus statement of the Catalan Associations of Anesthesiology and Hypertension]. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2009; 56:493-502. [PMID: 19994618 DOI: 10.1016/s0034-9356(09)70440-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
The prevalence of hypertension is high in the surgical population. Differing practices and the absence of consensus among physicians involved in caring for hypertensive patients has made it one of the most frequent reasons for cancelling scheduled surgery. The aim of this consensus statement is to outline a practical approach to managing the hypertensive surgical patient. Hypertension is associated with increased risk of perioperative complications, particularly those related to systemic effects and notable fluctuations in blood pressure during surgery. Preoperative assessment should center on a search for signs and symptoms of target organ damage. The anesthesiologist should seek to reduce perioperative fluctuations in arterial pressure, particularly guarding against sustained hypotension. After surgery, antihypertensive medication should be resumed as soon as possible.
Collapse
Affiliation(s)
- P Sierra
- Servicio de Anestesiología y Reanimación, Fundación Puigvert, Barcelona.
| | | | | | | | | | | |
Collapse
|
11
|
Documento de consenso sobre hipertensión arterial y anestesia de las Sociedades Catalanas de Anestesiología e Hipertensión Arterial. HIPERTENSION Y RIESGO VASCULAR 2009. [DOI: 10.1016/j.hipert.2009.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|