Cross-sectional study about perioperative management of Blood Pressure and effects of anaesthesia in hypertensive patients undergoing general & orthopaedic surgery

Abstract

Introduction: Hypertension is regarded as an additional risk factor during anaesthesia. There is not enough Indian evidence in literature regarding antihypertensive usage and its implications during perioperative period in patients undergoing general & orthopedic surgery. This drove us to conduct this study. Methods: Single centre cross-sectional observational study conducted in a General Surgery and Orthopaedics wards of a Tertiary care hospital. The data was collected from the period of first visit by the anaesthetist to 24 h’ postoperative period of the operated hypertensive patients. The variables accounted were of antihypertensive medications, anaesthesia drugs, hemodynamics, blood loss and fluids used. The data was analysed by using descriptive statistics, nonparametric tests and P < 0.05 was considered as significant. Results: 180 patients had median age of 65 years (Interquartile range – 20). Calcium channel Blockers were the most common class and Amlodipine was most common antihypertensive medication used during perioperative period. 132 patients took antihypertensive medication on the morning of the surgery. In 136 patients’ antihypertensive medication was started within 24 h’ postoperative period. Bupivacaine was most common anaesthetic drug used. Intraoperative fall in SBP (Systolic Blood Pressure) was found in 31 patients, and rises were found in 7 patients. Also, intraoperative fall in DBP (Diastolic Blood Pressure) was found in 13 patients, and rises were found in 9 patients. Intraoperative hemodynamic changes were managed appropriately by the anaesthetist. The median IV fluids given intraoperatively was 1375 ml (Interquartile range – 700). Median blood loss was 272 ml (Interquartile range – 250). Conclusion: Antihypertensive medications use during perioperative period were not associated with major hemodynamic changes. Keywords: General surgery, Orthopaedics, Hemodynamics