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Anaesthesiology > Hypertension > Flashcards

Hypertension Flashcards

1
Q

What are the long term effects of hypertension?

A
  1. Left ventricular Hypertension
  2. coronary artery disease
  3. Renal dysfunction
  4. Cerebrovascular disease
  5. Retinal involvement
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2
Q

What techniques intra-operatively can we use to ensure that the patient does not get hypertensive?

A
  1. Make sure the patient is in deep anaesthesia
  2. opiates(Remifentanil)
  3. lignocaine
  4. b-blocker
  5. avoid prolonged laryngoscopy
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3
Q

Which patients are the most high risk peri-operatively?

A

-Patients that are uncontrolled, undiagnosed and untreated

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4
Q

If a patient presents with a diastolic BP of 120 mmHg what would you do?

A

-postpone if elective surgery and resume in 2 weeks

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5
Q

Between hypertension and hypotension, what is more dangerous?

A

Hypotension is more dangerous

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6
Q

Why do we stop ACE-inhibitors before surgery?

A

They can irritate the airways

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7
Q

Which drug do we use particularly in pregnancy?

A

We use methyl-dopa

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8
Q

What happens to the hypertensive patients arteries?

A
  • The intravascular volume is 15% less than in a normotensive patient
  • The internal radius of the patients lumen is also dramatically smaller
  • this in turn leads to a more pronounced fall in BP in these patients
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9
Q

Which direction does the autoregulation curve deviate to as a result of hypertension

A

-It deviates to the right

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10
Q

How long does it take for the hypertensive patient to go back to normal?

A

-about 6 months

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11
Q

What organs are affected in addition to hypertension?

A
  1. Coronary artery disease
  2. Renal disease
  3. Cerebrovascular disease
  4. Eye involvement-look at the blood vessels to determine how bad the hypertension is
  5. Salt intake- perioperatively it means that the patient should not get sodium containing fluids because it can exarcerbate the hypertension
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12
Q

What does hypertension do to the left ventricle?

A

-causes risk of increased workload

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13
Q

What does hypotension do the patient perioperatively?

A

-It causes decreased perfusion to the organs

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14
Q

What is the blood pressure value we would like to see in these patients?

A
  • about 140/90mmHg

- Even 180/110 mmHg and less can be accepted

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15
Q

What do you do if you find out the patient is hypertensive pre-opertively?

A
  • If less than 180/110mmHg and surgery cannot wait until 6 months later then continue with surgery
  • if more than 180/110mmHg and surgery can wait then do the operation 6 months later
  • if it is an emergency continue but monitor the 25% variation closely
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16
Q

Which drug would you prefer in a hypertensive patient?

A

-I would choose etomidate because it is cardiovascularly stable

17
Q

Which drug would you not use in a hypertensive patient?

A

Ketamine-it increases the blood pressure

18
Q

Which muscle relaxants must we avoid with hypertension

A

Pancuronium

19
Q

What can we do to limit the effect of laryngoscopy, endotracheal intubation and surgical stimulation on blood pressure?

A
  • we can give short acting opiates
  • nitrate which a direct vasodilator
  • labetolol which is a combination of a alpha and beta adrenergic blocker
20
Q

What should the urine output look like intra-op to determine organ perfusion?

A

It should be about 0,25 ml.kg.hour

21
Q

In epidural or spinal anaesthesia will the blood pressure of the patient increase or decrease?

A

It will decrease

22
Q

What can we do to combat the fall of blood pressure in these patients?

A

-give fluids pre-operatively and during the operation and use phenylephrine which is a strong alpha agonist

23
Q

What should you ensure happens post-operatively for these patients?

A

-That they get analgesia

24
Q

Name the 5 groups of drugs that we would suggest to a patient that is hypertensive?

A
  1. Diuretics
  2. Calcium channel blockers
  3. Methyl-dopa
  4. Ace inhibitors
  5. B blockers(atenolol)
25
Q

What is systolic blood pressure?

A

-the stroke volume at that is ejected into the vascular tree/aorta

26
Q

What is the diastolic blood pressure?

A

-the blood trickling into the arteriolar bed

27
Q

What is autoregulation and what does it mean?

A
  • autoregulation is the relationship between the perfusion pressure and the blood flow
  • it means that within certain pressure limits the blood flow will be constant
28
Q

What are the clinical signs of hypertension on ECG?

A
  • Left axis deviation
  • p mitrale (left atrial enlargement)
  • V1 and V6 larger than 35mm
29
Q

On auscultation?

A
  • a heaving apex that is non displaced

- loud S2 split

Anaesthesiology (25 decks)

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