Hypertension in the surgical patient: management of blood pressure and anesthesia
Fawzy G. Estafanous, MDAddress reprint requests to F.G.E., Department of Cardiothoracic Anesthesia, The Cleveland Clinic Foundation, One Clinic Center, 9500 Euclid Avenue, Cleveland, Ohio 44195.
Although hypertension has always been a high risk factor during anesthesia and surgery, risk can be reduced by preoperative control of blood pressure, evaluation of the patient to determine risk factors that can exacerbate blood pressure rises, and continuation of preoperative antihypertensive therapy. Patient hemodynamics must be monitored to manage blood pressure fluctuations and signs of ischemia as early as possible. Selection of anesthetic and adjuvant agents must be tailored to the patients, the agents must be administered carefully and in a timely fashion, and the anesthesiologist must be aware of the relevant variables. Increased knowledge of the pathophysiology of hypertension, antihypertensive therapy, and the development of new anesthetics and muscle relaxants with minimum hemodynamic effects has helped minimize complications related to perioperative hypertension.