Optimal perioperative management of arterial blood pressure

Abstract

Laurent Lonjaret,1 Olivier Lairez,2 Vincent Minville,3 Thomas Geeraerts3 1Department of Anesthesiology and Intensive Care, Clinique des eaux claires, Baie-Mahault, France; 2Department of Cardiology, 3Department of Anesthesiology and Intensive Care, University Hospital of Toulouse, University Toulouse III - Paul Sabatier, Toulouse, France Abstract: Perioperative blood pressure management is a key factor of patient care for anesthetists, as perioperative hemodynamic instability is associated with cardiovascular complications. Hypertension is an independent predictive factor of cardiac adverse events in noncardiac surgery. Intraoperative hypotension is one of the most encountered factors associated with death related to anesthesia. In the preoperative setting, the majority of antihypertensive medications should be continued until surgery. Only renin-angiotensin system antagonists may be stopped. Hypertension, especially in the case of mild to moderate hypertension, is not a cause for delaying surgery. During the intraoperative period, anesthesia leads to hypotension. Hypotension episodes should be promptly treated by intravenous vasopressors, and according to their etiology. In the postoperative setting, hypertension predominates. Continuation of antihypertensive medications and postoperative care may be insufficient. In these cases, intravenous antihypertensive treatments are used to control blood pressure elevation. Keywords: hypertension, hypotension, perioperative, blood pressure control