How anesthesiologists deal with perioperative hypertension

  Hypertension is a chronic systemic disease and the most important factor in the morbidity and death of heart disease, stroke, and kidney disease. According to statistics, there are about 245 million hypertensive patients in my country. However, the changes in physiological functions of hypertensive patients during the perioperative period are not stable, which requires anesthesiologists to be more cautious to ensure that the entire anesthesia process is scientific and reasonable.
  The concept
  of perioperative hypertension refers to the sharp fluctuations in blood pressure associated with surgical hospitalization, including preoperative, intraoperative and surgical (generally 3 to 4 days). Among them, postoperative hypertension often occurs within half an hour after the operation is completed, and may last for 45 hours. During this period, if no appropriate treatment is taken, the patient is prone to a series of problems such as cerebrovascular accident or myocardial infarction. In the carotid abdominal cavity and peripheral vascular surgery, perioperative hypertension is very prone to occur, but this type of hypertension is not the most serious. The most serious hypertension often occurs in the operation of large blood vessels and the heart. According to the survey of medical institutions in my country, it is found that the elderly have the highest proportion of perioperative hypertension, which increases the risk of surgery and anesthesia for the elderly to a certain extent. And the elderly often have cerebrovascular diseases, which are very easy to cause other cerebrovascular complications during anesthesia. Therefore, anesthesiologists must pay attention to whether there will be accidents in hypertensive patients during the perioperative period. Only by making corresponding medical assessments and rational judgments can we effectively deal with the various risks of hypertensive patients in the perioperative period.
  of Perioperative Hypertension The main challenge posed by perioperative hypertension is that it is very prone to various types of high-risk complications during anesthesia, such as myocardial infarction, myocardial ischemia or Hypertensive encephalopathy, if the corresponding treatment plan is not adopted, is likely to cause organ failure and threaten the life of the patient. Therefore, before the operation, it is necessary to determine the anesthesia plan according to the actual situation of the patient, and to do relevant preventive treatment and prepare corresponding therapeutic drugs. In addition, perioperative hypertension may also cause hypotension, mainly because the blood pressure changes in patients during the perioperative period are more drastic. Therefore, the anesthesiologist must do a good job in the corresponding preventive work according to the patient’s condition to ensure that the entire operation process can be carried out smoothly.
  Anesthesiologists’ measures
  to Control the timing
  of treatment From the perspective of the actual development of medicine in China, there is no unified concept of the scope of perioperative safety. However, according to the relevant regulations on perioperative blood pressure control in cardiac surgery, a large number of anesthesiologists will judge the safe range of perioperative period according to their own experience standards, and the relevant experience standards are relatively consistent. Generally speaking, during the anesthesia process, the anesthetist will control the blood pressure of the patient during and after the operation to fluctuate around 20% of the blood pressure before the operation. This requires anesthesiologists to pay attention to good medication standards, fundamentally improve the safety of surgery, and avoid a series of adverse effects caused by perioperative hypertension.
  Perfect preoperative evaluation
  In the preoperative ward rounds, if the anesthetist finds that the patient has a history of hypertension, although the patient is controlled by medication before hospitalization, but the medication is irregular, then attention needs to be paid. Before the operation, the patient will feel nervous and anxious, leading to an increase in blood pressure. At this time, the anesthesiologist must use the data to determine whether the patient has undergone a comprehensive preoperative examination and evaluation. If not, the surgeon may think that the patient’s hospital blood pressure is not high, and the daily control status is relatively good. At this time, insisting on the planned operation will be more harmful to the patient. Therefore, in the actual operation process, anesthesiologists must do a good job in the preoperative assessment of hypertensive patients, and these potential risk factors must be taken into account during ward rounds, and they must take corresponding responsibilities both for patients and themselves. responsibility.
  Carry out anesthesia work scientifically
  Correct anesthesia methods and scientific use of anesthesia drugs can fundamentally improve the safety of anesthesia. In general, the cause of perioperative myocardial ischemia is the failure to effectively control blood pressure during anesthesia. In fact, if the anesthetist can adopt a standardized and scientific anesthesia plan, it will not only reduce the incidence of perioperative myocardial ischemia and myocardial infarction, but also make the effect of antihypertensive drugs more and more effective throughout the operation. Stronger, more precise control of blood pressure. At present, the anesthesia room in our country mainly adopts resting compound anesthesia, and all short-acting drugs are used in the anesthesia process, such as propofol. These drugs are also very effective in controlling high blood pressure. However, it should be noted that the anesthetist must use the drug scientifically according to the characteristics of the drug to avoid side effects.
  Anesthesia countermeasures and progress in hypertensive patients
  If hypertension is not controlled, it will lead to myocardial ischemia in the perioperative period and further increase the incidence of heart disease. In this case, the anesthesia surgery performed on hypertensive patients should be distinguished from common anesthesia surgery, because common anesthesia surgery drugs take a long time to act, the controllability is relatively low, and the antihypertensive effect is very strong. Now general anesthesia not only has a series of drugs such as the new intravenous anesthesia drug midazolam, but also has a brand-new inhalation anesthetic, which is very controllable. Therefore, intravenous inhalation compound anesthesia is often used before major anesthesia operations, which is also more suitable for hypertensive patients. Through the compound application of modern general anesthesia and epidural anesthesia, it can not only strengthen analgesia and muscle relaxation, but also can be used for postoperative analgesia. Because postoperative hypertensive patients will have a stress response, which increases the possibility of postoperative hemorrhage and myocardial ischemia, postoperative analgesia is very important, and can be regulated by a series of drugs such as Pelpin if necessary. The application of modern anesthesia technology not only ensures the safety of hypertensive patients during the perioperative period, but also reduces the probability of reoperation for patients.
  In the current context, perioperative anesthesia for hypertensive patients has become an important topic in medical development. Through the use of new drugs and anesthesia techniques, the incidence of hypertensive patients has been reduced, and the pain suffered by patients has been reduced. Therefore, major hospitals must pay attention to perioperative anesthesia for hypertensive patients, and study new anesthetic drugs to prevent hypertensive patients from perioperative myocardial ischemia and cardiovascular diseases such as coronary heart disease.
  As an anesthesiologist, when facing hypertensive patients, we must fully understand hypertension, especially the progression and subtypes of hypertension, and the impact of anesthesia on disease outcome. Mature anesthesia techniques can not only reduce the suffering of hypertensive patients, avoid a series of sequelae, but also reduce the operating pressure of surgeons.