HTN Flashcards
What is HTN
BP greater than 140/90 on at least two readings
Readings should be 1-2 weeks apart
How many adults have HTN in the US
About 24%
What causes essential HTN
Unknown
Strong genetic link
Associated with ETOH, smoking, OSA
Essential HTN makes up what percentage of HTN
95%
Secondary HTN is caused by
Renal problems (primary cause) Endocrine problems Pregnancy Neuro dysfunction Drug induced OSA
Tx for essential HTN
Lifestyle modification- for those with no CV disease or end organ damage. We know how Dr.E feels about these…
Drugs for anyone with increased morbidity/mortality risk and/or end organ damage (i.e. everyone…)
Lifestyle mods for HTN
Weight loss Decrease ETOH Increase physical activity Adequate Ca and K intake Decrease Na intake Stop smoking
Tx for secondary HTN
Treat the underlying cause if possible- typically related to renal stenosis or primary aldosteronism, so surg
Drugs are also appropriate if underlying cause cannot be corrected
Considerations for Beta blockers
Rebound SNS stim
AVOID in asthmatics, COPD, CHF, HB, Sick sinus syndome
Considerations for methyldopa
Rebound HTN
DECREASED anesthetic requirements
Considerations for clonidine
Rebound HTN
DECREASED anesthetic requirements
Considerations for prazosin (alpha 1 blockers)
Compensatory vasoconstriction is lost, so large drop in BP may occur with spinal/epidural block
Considerations for hydralazine
ANGINA in pts with ischemic heart disease
Considerations for ACE inhibitors
Associated with hemodynamic instability and low BP during GETA
Considerations for ARBs
Decreased BP during induction
HTN crisis- What is it, what can it result in, and how is it treated
Acute DBP > 130 mmHg
Can result in encephalopathy, congestive HF, SAH, renal insufficiency
Decrease by 20% during first two hours, continue to normalize BP over next 24-48 hours
Management for HTN crisis
Place a-line
SNP 0.5-10mcg/kg/min IV is drug of choice
Nitro 5-200mcg/min IV
Labetalol 40-80mg IV q10min
Esmolol 50-300 mcg/kg/min IV
Things to consider when a pt has essential HTN
Is it controlled?
Is the surg emergent or elective?
Evidence of end organ damage? (Angina, CHF, CVA, Renal insufficiency, PVD)
Drug regimen?
Goal for BP in HTN?
Stay within 20% of baseline
Management of induction with HTN
Anticipate exaggerated SBP changes
Limit duration of DVL
Attenuate DVL response with additional opioid, increase VA, use lidocaine (IV or topical)
Maintenance of anesthesia with HTN
VA is good at blunting HTN response
Monitor for myocardial ischemia
Minimize wide shifts in hemodynamics
Postop management with HTN
Anticipate periods of systemic HTN
Minimize SNS responses secondary to pain and N/V
Continue to monitor for end organ damage
Intraop HTN is usually due to
PAIN
Tx for intraop hypotension
Decrease anesthetic depth (is your gas still set for overpressure?)
Fluids
Neo gtt may be needed if unable to maintain adequate anesthesia depth
Is there a new junctional rhythm?- maintain normocapnia, avoid high concentrations of IA
Monitoring to consider for HTN pts
5 lead EKG
A-line, CVP, PA if major surg and ventricular dysfunction
TEE
Emergence with HTN
Minimize SNS outflow. Consider pluses and minuses of- Narcotics Lidocaine Labetalol, Esmolol, NTG Deep extubation
If pain is controlled, treat postop HTN with
Hydralazine 2.5-10mg IV q10-20 min (long onset time)
Labetalol 5-20mg IV q10 min
Nipride 0.5-10mcg/kg/min IV
