HTN Flashcards
Essential htn
Causes
Unknown etiology. 95% of cases. Genetic link or thru etoh, tobacco use, OSA
Secondary htn cause
Known. 5% of all kinds. Renal, endo, pregnancy, neuro, drug induced, osa
Previous mi anti htn drugs 3
Ace i, ald antag, bb
HF anti htn drugs 5
Acei, ald antag, arb, bb, diuretic
CAD high risk anti htn drugs 4
Ace i, bb, ccb, diuretic
DM anti htn drugs 5
Ace i, arb, bb, ccb, diuretic
CKD anti htn drugs 2
Ace i, arb
Recurrent stroke prevention anti htn drugs 2
Ace i, diuretic
Considerations: BB
Rebound sns stim, avoid in athsma/COPD/CHF/hb/sick sinus
Considerations: methyldopa
Rebound htn, decreases anesthesia requirements
Considerations: clonidine
Rebound htn, decreases anes reqs
Considerations: prazosin
Compensatory vasoconstriction blocked, dec bp during spinal/epidural may be exaggerated
Considerations: hydralazine
Angina in pts w ischemic heart disease
Considerations: ACE inhib
Assoc w hemodynamic instab and dec bp during GETA
Ang II blockers consid
Dec bp w induction
Htn crisis: sign, what is can result in
> 130 DBP. Can result in: encephalopathy, CHF, SAH, renal ins
Htn crisis goal for treatment
Dec DBP by 20% 1st 2 hrs of tx. Tx 24-48 hrs to dec bp gradually
Tx htn crisis: place what, meds
A line. NTP .5-10 mcg/kg/min (DOC, short DOA). NTG 5-200 mcg/min. Labetolol 40-80 mg q10 min. Esmolol 50-300 mcg/kg/min
Questions to ask for anesthesia management of essential htn
Controlled or not. Emergent vs elective sx. End organ damage: angina, CHF, cva, renal insuff, PVD. Drug reg
Induction goals
Minimize sns stim w laryngoscopy and intub. Atten laryn reflexes w additional narcotics, inc VA, lidocaine
Maintenance and post op goals
Adjust anesthesia depth to minimize hemodynamics shifts. Postop min SNS secondary to surgical pain and NV
How to minimize SNS w induc
Lidocaine 1-1.5 mg/kg IV. LTA 2-4% 5 cc. Opiates, volatiles
Maintenance techniques: 4
IA easily adjusted (low BG solub), balanced technique, have ephedrine and neo ready, neo gtt if unable to get adequate anesthetic depth
Intraop hypertension: incidence higher in who, d/t what, tx 5
Essential htn, pain. Narcotics, IAs, BB, ntg, nipride
Intraop hypotension tx: 4
Decrease anesthetic depth, fluids, sympathomimetics, check rhythm (is it junctional? Maintain normocapnia and avoid high IA conc)
Monitoring for htn pts
5 lead EKG, Aline/CVP/PA if extensive surgery and ventricular dysfunction, TEE
Emergence tips
Controlled, minimize SNS outflow. Use of: narcotics, lidocaine, labetolol/esmolol/NTG, deep extubation
Post op htn: tx 4
Opiates. If no pain: hydralazine (2.5-10 mg q 10-20 min), labetolol (5-20 mg q10 min), nipride (0.5-10 mcg/kg/min)
