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By Dennis T. Mangano M.D., Ph.D (auth.), Theodore H. Stanley MD, W. Clayton Petty MD (eds.)

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ISBN-13: 9780898385595

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ISBN-13: 9780898385717

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Additional resources for Anesthesia and the Cardiovascular System: Annual Utah postgraduate course in anesthesiology 1984

Example text

Strong premedication will help to minimize undesirable hypertensive episodes during transfer from his room to the surgical suite. We routinely use transdermal sustained-release nitroglycerin as a component of premedication. It is valuable in the presence of coronary artery disease and it helps to minimize an undue rise in blood pressure prior to induction of anesthesia. Preoperative Hypertensive Therapy The question of discontinuation of antihypertensive treatment before anesthesia is a legacy of the early days when little was known about the mechanisms influencing blood pressure control and the pharmacology of drugs, and because of the widespread use of long-acting sympatholytic agents (22-25).

Mild hypertension (sustained diastolic pressures greater than 100 mmHg): Mortality rate approximately three times that of a normoten- sive population. 3. Moderate hypertension (diastolic pressures 105 to 115 mmHg): Mortality rate over three times that of normotensive population. 4. Severe hypertension (diastolic pressure greater than 115 mmHg): 25% of these patients, if untreated, develop severe complications within a short time after initial detection. PATHOPHYSIOLOGIC MECHANISMS OF HYPERTENSION Recently, Tarazi et al (14) classified hypertension according to the pathologic and hemodynamic changes affecting the choice of therapy.

It is important to realize that the advent of invasive monitors have greatly increased the abil ity to better assess the patient intraoperatively than was possible in the past. In the past decade emergency situations have dictated the author to provide anesthesia for patients who are on monoamine oxidase inhibitors for general anesthesia. The use of narcotic-nitrous oxide-oxygen- relaxant anesthesia regimen with a continuous monitoring of arterial pressure and central venous pressure have allowed reasonable anesthetic management without morbidity.

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Anesthesia and the Cardiovascular System: Annual Utah postgraduate course in anesthesiology 1984 by Dennis T. Mangano M.D., Ph.D (auth.), Theodore H. Stanley MD, W. Clayton Petty MD (eds.)


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