HTN

Question 1

Essential htn

Causes

Answer 1

Unknown etiology. 95% of cases. Genetic link or thru etoh, tobacco use, OSA

Question 2

Secondary htn cause

Answer 2

Known. 5% of all kinds. Renal, endo, pregnancy, neuro, drug induced, osa

Question 3

Previous mi anti htn drugs 3

Answer 3

Ace i, ald antag, bb

Question 4

HF anti htn drugs 5

Answer 4

Acei, ald antag, arb, bb, diuretic

Question 5

CAD high risk anti htn drugs 4

Answer 5

Ace i, bb, ccb, diuretic

Question 6

DM anti htn drugs 5

Answer 6

Ace i, arb, bb, ccb, diuretic

Question 7

CKD anti htn drugs 2

Answer 7

Ace i, arb

Question 8

Recurrent stroke prevention anti htn drugs 2

Answer 8

Ace i, diuretic

Question 9

Considerations: BB

Answer 9

Rebound sns stim, avoid in athsma/COPD/CHF/hb/sick sinus

Question 10

Considerations: methyldopa

Answer 10

Rebound htn, decreases anesthesia requirements

Question 11

Considerations: clonidine

Answer 11

Rebound htn, decreases anes reqs

Question 12

Considerations: prazosin

Answer 12

Compensatory vasoconstriction blocked, dec bp during spinal/epidural may be exaggerated

Question 13

Considerations: hydralazine

Answer 13

Angina in pts w ischemic heart disease

Question 14

Considerations: ACE inhib

Answer 14

Assoc w hemodynamic instab and dec bp during GETA

Question 15

Ang II blockers consid

Answer 15

Dec bp w induction

Question 16

Htn crisis: sign, what is can result in

Answer 16

> 130 DBP. Can result in: encephalopathy, CHF, SAH, renal ins

Question 17

Htn crisis goal for treatment

Answer 17

Dec DBP by 20% 1st 2 hrs of tx. Tx 24-48 hrs to dec bp gradually

Question 18

Tx htn crisis: place what, meds

Answer 18

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

Question 19

Questions to ask for anesthesia management of essential htn

Answer 19

Controlled or not. Emergent vs elective sx. End organ damage: angina, CHF, cva, renal insuff, PVD. Drug reg

Question 20

Induction goals

Answer 20

Minimize sns stim w laryngoscopy and intub. Atten laryn reflexes w additional narcotics, inc VA, lidocaine

Question 21

Maintenance and post op goals

Answer 21

Adjust anesthesia depth to minimize hemodynamics shifts. Postop min SNS secondary to surgical pain and NV

Question 22

How to minimize SNS w induc

Answer 22

Lidocaine 1-1.5 mg/kg IV. LTA 2-4% 5 cc. Opiates, volatiles

Question 23

Maintenance techniques: 4

Answer 23

IA easily adjusted (low BG solub), balanced technique, have ephedrine and neo ready, neo gtt if unable to get adequate anesthetic depth

Question 24

Intraop hypertension: incidence higher in who, d/t what, tx 5

Answer 24

Essential htn, pain. Narcotics, IAs, BB, ntg, nipride

Question 25

Intraop hypotension tx: 4

Answer 25

Decrease anesthetic depth, fluids, sympathomimetics, check rhythm (is it junctional? Maintain normocapnia and avoid high IA conc)

Question 26

Monitoring for htn pts

Answer 26

5 lead EKG, Aline/CVP/PA if extensive surgery and ventricular dysfunction, TEE

Question 27

Emergence tips

Answer 27

Controlled, minimize SNS outflow. Use of: narcotics, lidocaine, labetolol/esmolol/NTG, deep extubation

Question 28

Post op htn: tx 4

Answer 28

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)