Peri-Operative Hypertensive Urgencies; Etiologic Factors and Therapeutic modalities used
CCCF ePoster library. Hadi Tohidi S. 11/13/19; 283412; EP111
Sana Mohseni and Hadi Tohidi
Sana Mohseni and  Hadi Tohidi
Login now to access Regular content available to all registered users.

You may also access this content "anytime, anywhere" with the Free MULTILEARNING App for iOS and Android
Abstract
Rate & Comment (0)
ePoster
Topic: Retrospective or Prospective Cohort Study or Case Series

Shafiee, Mohammad Ali1; Mohseni, Sana1; Tohidi, Hadi1; Rashidi, Negin1; Montazeri, Mahdi1

Division of General Internal Medicine, Departement of Medicine, University of Toronto, University Health Network, Toronto General Hospital, Toronto, Canada


INTRODUCTION: Perioperative hypertension is seen commonly in up to 20% of patients undergoing surgery(1). Hypotension and hypertension have been reported to be associated with postoperative complications and mortality(2-4). Occasionally patients can have a hypertensive urgency or emergency during perioperative period due to hemodynamic changes in response to anesthesia and surgery. Such severe hypertension in operative patients usually occurs in chronic hypertension and other comorbidities. Identifying the underlying condition and factors responsible for acute severe rise in blood pressure in the unique intra/postoperative time is fundamental to effective treatment and prevention of perioperative hypertensive urgency and its complications. Hypertensive urgencies are situations associated with severe BP elevation in patients without acute or impending target organ damage.
OBJECTIVES: We hypothesized that finding the patients characteristics and etiologies of perioperative hypertensive urgency and assessing the treatments used can affect our evaluation in the future and prevent postoperative complications.
METHODS: We performed an observational study using data from University Health Network hospitals between 2015 and 2019 for noncardiac surgery to find patients with perioperative hypertensive urgency(defined as SBP>180 or DBP>120 or MAP>140 and >20% rise from the baseline BP) during or within 2 hours after surgery for whom all the required data was available. Patients with an acute intracranial event were excluded. Finally 300 patients were enrolled and the EPRs were reviewed to analyze the etiology of hypertension urgency and assess the treatment methods used. The research proposal was approved by the Research Ethics Board at UHN.
RESULTS: Based on our preliminary result, of all cases 38% had poorly controlled HTN before the surgery. Volume overload was the main reason in 16% of cases. Alcohol withdrawal detected in 8%. ESRD patients on hemo/peritoneal dialysis and other CKD patients comprised of 35% of cases, many of them received liberal fluid therapy and later needed aggressive diuretic therapy to lower BP. Withdrawal of antihypertensive medication was seen in 2% of all subjects. Renovascular HTN was detected in 6%, half of which diagnosed after surgery. primary aldosteronism and pheochromocytoma each were 1% of subjects.
29% had 3 or more etiologic factors. 31% of patients with hypertensive urgency had an episode of intraoperative hypotension requiring treatment and in 34% of them treatment including vasopressors led to severe HTN.
CONCLUSION: Volume overload in general and specially in ESRD patients during operation can cause hypertensive urgency in a relatively significant number of patients. So adequate treatment of HTN and hypervolemia before surgery is crucial in preventing HTN crises. We suggest performing prolonged and more frequent hemodialysis in ESRD individuals and more stringent fluid management during surgery for such patients.
The percentage of patients with post-op HTN crisis due to alcohol withdrawal was more than expected, they may remain unrecognized possibly due to incomplete history or refusal/denial of patients. Labile BP was seen in a significant number of perioperative HTN urgencies which requires more cautious management. In this study we found that a significant portion of patients have noticeable causes for Perioperative hypertensive urgency which are quite preventable.


1.Charlson ME, MacKenzie CR, Gold JP, Ales KL, Topkins M, Shires GT: Intraoperative blood pressure. What patterns identify patients at risk for postoperative complications? Ann Surg 1990; 212:567–80

2. Reich DL, Bennett-Guerrero E, Bodian CA, Hossain S, Winfree W, Krol M: Intraoperative tachycardia and hypertension are independently associated with adverse outcome in noncardiac surgery of long duration. Anesth Analg 2002; 95:273–7

3. Monk TG, Saini V, Weldon BC, Sigl JC: Anesthetic management and one-year mortality after noncardiac surgery. Anesth Analg 2005; 100:4–10

4. Bijker JB, Persoon S, Peelen LM, Moons KG, Kalkman CJ, Kappelle LJ, van Klei WA: Intraoperative hypotension and perioperative ischemic stroke after general surgery: A nested case-control study. Anesthesiology 2012; 116:658–64

5. Walsh M, Devereaux PJ, Garg AX, Kurz A, Turan A, Rodseth RN, Cywinski J, Thabane L, Sessler DI: Relationship between intraoperative mean arterial pressure and clinical outcomes after noncardiac surgery: Toward an empirical definition of hypotension. Anesthesiology 2013; 119:507–15

6. Whelton PK, Carey RM, Aronow WS, Casey DE Jr, Collins KJ, Dennison Himmelfarb C, DePalma SM, Gidding S, Jamerson KA, Jones DW, MacLaughlin EJ, Muntner P, Ovbiagele B, Smith SC Jr, Spencer CC, Stafford RS, Taler SJ, Thomas RJ, Williams KA Sr, Williamson JD, Wright JT Jr. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/ NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension. 2018;71:1269–1324. DOI: 10.1161/HYP.0000000000000066.

    This eLearning portal is powered by:
    This eLearning portal is powered by MULTIEPORTAL
Anonymous User Privacy Preferences

Strictly Necessary Cookies (Always Active)

MULTILEARNING platforms and tools hereinafter referred as “MLG SOFTWARE” are provided to you as pure educational platforms/services requiring cookies to operate. In the case of the MLG SOFTWARE, cookies are essential for the Platform to function properly for the provision of education. If these cookies are disabled, a large subset of the functionality provided by the Platform will either be unavailable or cease to work as expected. The MLG SOFTWARE do not capture non-essential activities such as menu items and listings you click on or pages viewed.


Performance Cookies

Performance cookies are used to analyse how visitors use a website in order to provide a better user experience.


Save Settings