The patient with hypertension undergoing surgery
| Autor: | Koen Lapage, Patrick Wouters |
|---|---|
| Rok vydání: | 2016 |
| Předmět: |
medicine.medical_specialty
MEDLINE Blood Pressure 030204 cardiovascular system & hematology Risk Assessment Perioperative Care 03 medical and health sciences 0302 clinical medicine 030202 anesthesiology Humans Medicine Anesthesia Intensive care medicine Antihypertensive Agents Anesthetics Spectroscopy Near-Infrared Perioperative medicine Perioperative management business.industry Task force Hemodynamic Monitoring Surgery Cardiac surgery Anesthesiology and Pain Medicine Blood pressure Hypertensive disease Echocardiography Surgical Procedures Operative Hypertension Practice Guidelines as Topic Perioperative care Hypotension business |
| Zdroj: | Current Opinion in Anaesthesiology. 29:397-402 |
| ISSN: | 0952-7907 |
| Popis: | General recommendations for the perioperative management of patients with hypertensive disease have not evolved much over the past 20 years, yet new pathophysiological concepts have emerged and new monitoring techniques are available today. In this review, we will discuss their significance and potential role in the modern perioperative care of hypertensive patients.For hypertensive patients, total cardiovascular risk rather than blood pressure (BP) alone should determine the preoperative strategy. Except for grade 3 hypertension, surgery should not be deferred on the basis of an elevated BP in the preoperative assessment.New data suggest that even brief hypotensive episodes during surgery may have significant impact on outcome. Isolated systolic hypertension is the predominant phenotype in elderly patients who may be particularly vulnerable to hypoperfusion in the perioperative setting.New monitoring techniques such as echocardiography and near-infrared spectroscopy may provide crucial information to optimize intraoperative control of BP based on an individual patient's pathophysiology.Hypertension is highly prevalent in patients presenting for surgery yet its impact on surgical outcome is still debated. Guidelines on risk stratification and perioperative hemodynamic management of patients with hypertensive disease remain sparse and cannot rely much on solid new evidence. Target organ damage associated with hypertensive disease rather than high BP per se appears to determine perioperative risk. In the absence of new data, an individualized and pathophysiology-based approach to control BP may be the best option to guide these patients through the perioperative period. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|