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8 - Perioperative management of hypertension

Published online by Cambridge University Press:  12 January 2010

By
Craig R. Keenan
Edited by
Michael F. Lubin ,
Robert B. Smith ,
Thomas F. Dodson ,
Nathan O. Spell  and
H. Kenneth Walker
Craig R. Keenan
Affiliation:
Department of Medicine, University of California, Davis, CA
Michael F. Lubin
Affiliation:
Emory University, Atlanta
Robert B. Smith
Affiliation:
Emory University, Atlanta
Thomas F. Dodson
Affiliation:
Emory University, Atlanta
Nathan O. Spell
Affiliation:
Emory University, Atlanta
H. Kenneth Walker
Affiliation:
Emory University, Atlanta
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Summary

Perioperative management of hypertension

Hypertension affects an estimated 50 million persons in the USA, including 25% of adults and more than 50% of individuals over age 65 years. Thus, many surgeons, anesthesiologists, primary care physicians, and consultants will care for surgical patients with hypertension. Hypertension can increase surgical risk, and it often causes end-organ damage of the brain, heart, and kidneys, with important implications for surgical risk and perioperative management. The essentials of diagnosis, evaluation, and treatment of hypertension have been detailed in recent reviews. This chapter concentrates on the preoperative risk assessment of hypertensive patients and on the perioperative management of hypertension.

Hemodynamic response to anesthesia

A discussion of perioperative hypertension requires a basic understanding of the physiologic responses to anesthesia in normotensive and hypertensive patients. There are four main periods during anesthesia: the induction, intubation, maintenance, and recovery periods. During induction, most patients have a fall in blood pressure. During laryngoscopy and intubation, the sympathetic nervous system is activated and blood pressure and heart rate rise. With deepening anesthesia, a decline in mean arterial pressure and heart rate occur due to the effects of pharmacologic agents, a decrease in sympathetic nervous system activity, and loss of the baroreceptor reflex. During recovery from anesthesia around the time of extubation, blood pressure and heart rate slowly increase in the first 15 minutes, and are accompanied by general arousal.

Patients with untreated hypertension can have exaggerated responses during all of these phases.

Type
Chapter
Information
Medical Management of the Surgical Patient
A Textbook of Perioperative Medicine
 , pp. 107 - 124
Publisher: Cambridge University Press
Print publication year: 2006

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References

Association AH. 2002 Heart and Stroke Statistical Update. Available at: http://www.american heart.org/downloadable/heart/10148328094661013190990123HS_State_02.pdf. Access verified January 23, 2003. 2002.
The sixth report of the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure. Arch. Intern. Med. 1997; 157: 2413–2446.CrossRef
Wolfsthal, S. D.Is blood pressure control necessary before surgery? Med. Clin. North Am. 1993; 77: 349–363.CrossRefGoogle ScholarPubMed
Prys-Roberts, C., Greene, L. T., Meloche, R., & Foex, P.Studies of anaesthesia in relation to hypertension. II. Haemodynamic consequences of induction and endotracheal intubation. Br. J. Anaesth. 1971; 43: 531–547.CrossRefGoogle ScholarPubMed
Prys-Roberts, C., Meloche, R., & Foex, P.Studies of anaesthesia in relation to hypertension. I. Cardiovascular responses of treated and untreated patients. Br. J. Anaesth. 1971; 43: 122–137.CrossRefGoogle ScholarPubMed
Fleisher, L. A.Preoperative evaluation of the patient with hypertension. J. Am. Med. Assoc. 2002; 287: 2043–2046.CrossRefGoogle ScholarPubMed
Goldman, L., Caldera, D. L., Nussbaum, S. R.et al. Multifactorial index of cardiac risk in noncardiac surgical procedures. N. Engl. J. Med. 1977; 297: 845–850.CrossRefGoogle ScholarPubMed
Goldman, L., Caldera, D. L., Southwick, F. S.et al. Cardiac risk factors and complications in non-cardiac surgery. Medicine (Baltimore) 1978; 57: 357–370.CrossRefGoogle ScholarPubMed
Goldman, L. & Caldera, D. L.Risks of general anesthesia and elective operation in the hypertensive patient. Anesthesiology 1979; 50: 285–292.CrossRefGoogle ScholarPubMed
Goldman, L.Cardiac risks and complications of noncardiac surgery. Ann. Intern. Med. 1983; 98: 504–513.CrossRefGoogle ScholarPubMed
Forrest, J. B., Rehder, K., Cahalan, M. K., & Goldsmith, C. H.Multicenter study of general anesthesia. III. Predictors of severe perioperative adverse outcomes. Anesthesiology 1992; 76: 3–15.CrossRefGoogle ScholarPubMed
Detsky, A. S., Abrams, H. B., McLaughlin, J. R.et al. Predicting cardiac complications in patients undergoing non-cardiac surgery. J. Gen. Intern. Med. 1986; 1: 211–219.CrossRefGoogle ScholarPubMed
Lee, T. H., Marcantonio, E. R., Mangione, C. M.et al. Derivation and prospective validation of a simple index for prediction of cardiac risk of major noncardiac surgery. Circulation 1999; 100: 1043–1049.CrossRefGoogle ScholarPubMed
Aronson, S., Boisvert, D., & Lapp, W.Isolated systolic hypertension is associated with adverse outcomes from coronary artery bypass grafting surgery. Anesth. Analg. 2002; 94: 1079–1084, table of contents.CrossRefGoogle ScholarPubMed
Prys-Roberts, C.Isolated systolic hypertension: pressure on the anaesthetist? Anaesthesia 2001; 56: 505–510.CrossRefGoogle ScholarPubMed
Stone, J. G., Foex, P., Sear, J. W., Johnson, L. L., Khambatta, H. J., & Triner, L.Risk of myocardial ischaemia during anaesthesia in treated and untreated hypertensive patients. Br. J. Anaesth. 1988; 61: 675–679.CrossRefGoogle ScholarPubMed
Charlson, M. E., MacKenzie, C. R., Gold, J. P.et al. The preoperative and intraoperative hemodynamic predictors of postoperative myocardial infarction or ischemia in patients undergoing noncardiac surgery. Ann. Surg. 1989; 210: 637–648.CrossRefGoogle ScholarPubMed
Slogoff, S. & Keats, A. S.Does perioperative myocardial ischemia lead to postoperative myocardial infarction? Anesthesiology 1985; 62: 107–114.CrossRefGoogle ScholarPubMed
Slogoff, S. & Keats, A. S.Further observations on perioperative myocardial ischemia. Anesthesiology 1986; 65: 539–542.CrossRefGoogle ScholarPubMed
Raby, K. E., Barry, J., Creager, M. A., Cook, E. F., Weisberg, M. C., & Goldman, L.Detection and significance of intraoperative and postoperative myocardial ischemia in peripheral vascular surgery. J. Am. Med. Assoc. 1992; 268: 222–227.CrossRefGoogle ScholarPubMed
Ashton, C. M., Petersen, N. J., Wray, N. P.et al. The incidence of perioperative myocardial infarction in men undergoing noncardiac surgery. Ann. Intern. Med. 1993; 118: 504–510.CrossRefGoogle ScholarPubMed
Browner, W. S., Li, J., & Mangano, D. T.In-hospital and long-term mortality in male veterans following noncardiac surgery. The Study of Perioperative Ischemia Research Group. J. Am. Med. Assoc. 1992; 268: 228–232.CrossRefGoogle Scholar
Mangano, D. T., Browner, W. S., Hollenberg, M., Li, J., & Tateo, I. M.Long-term cardiac prognosis following noncardiac surgery. The Study of Perioperative Ischemia Research Group. J. Am. Med. Assoc. 1992; 268: 233–239.CrossRefGoogle Scholar
Hollenberg, M., Mangano, D. T., Browner, W. S., London, M. J., Tubau, J. F., & Tateo, I. M.Predictors of postoperative myocardial ischemia in patients undergoing noncardiac surgery. The Study of Perioperative Ischemia Research Group. J. Am. Med. Assoc. 1992; 268: 205–209.CrossRefGoogle Scholar
Mangano, D. T., Browner, W. S., Hollenberg, M., London, M. J., Tubau, J. F., & Tateo, I. M.Association of perioperative myocardial ischemia with cardiac morbidity and mortality in men undergoing noncardiac surgery. The Study of Perioperative Ischemia Research Group. N. Engl. J. Med. 1990; 323: 1781–1788.CrossRefGoogle Scholar
Sheifer, S. E., Manolio, T. A., & Gersh, B. J.Unrecognized myocardial infarction. Ann. Intern. Med. 2001; 135: 801–811.CrossRefGoogle ScholarPubMed
Eagle, K. A., Berger, P. B., Calkins, H.et al. ACC/AHA guideline update for perioperative cardiovascular evaluation for noncardiac surgery – executive summary. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1996 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery). Circulation 2002; 105: 1257–1267.Google Scholar
Charlson, M. E., MacKenzie, C. R., Gold, J. P., Ales, K. L., Topkins, M., & Shires, G. T.Risk for postoperative congestive heart failure. Surg. Gynecol. Obstet. 1991; 172: 95–104.Google ScholarPubMed
Landesberg, G., Einav, S., Christopherson, R.et al. Perioperative ischemia and cardiac complications in major vascular surgery: importance of the preoperative twelve-lead electrocardiogram. J. Vasc. Surg. 1997; 26: 570–578.CrossRefGoogle ScholarPubMed
Wahr, J. A., Parks, R., Boisvert, D.et al. Preoperative serum potassium levels and perioperative outcomes in cardiac surgery patients. Multicenter Study of Perioperative Ischemia Research Group. J. Am. Med. Assoc. 1999; 281: 2203–2210.CrossRefGoogle ScholarPubMed
Hirsch, I. A., Tomlinson, D. L., Slogoff, S., & Keats, A. S.The overstated risk of preoperative hypokalemia. Anesth. Analg. 1988; 67: 131–136.CrossRefGoogle ScholarPubMed
Koide, M. & Waud, B. E.Serum potassium concentrations after succinylcholine in patients with renal failure. Anesthesiology 1972; 36: 142–145.CrossRefGoogle ScholarPubMed
Palda, V. A. & Detsky, A. S.Perioperative assessment and management of risk from coronary artery disease. Ann. Intern. Med. 1997; 127: 313–328.CrossRefGoogle ScholarPubMed
Ladenson, P. W., Levin, A. A., Ridgway, E. C., & Daniels, G. H.Complications of surgery in hypothyroid patients. Am. J. Med. 1984; 77: 261–266.CrossRefGoogle ScholarPubMed
Edwards, R.Thyroid and parathyroid disease. Int. Anesth. Clin. 1997; 35: 62.CrossRefGoogle ScholarPubMed
Sellevold, O. F., Raeder, J., & Stenseth, R.Undiagnosed phaeochromocytoma in the perioperative period. Case reports. Acta Anaesthesiol. Scand. 1985; 29: 474–479.CrossRefGoogle ScholarPubMed
Lenders, J. W., Pacak, K., Walther, M. M., et al. Biochemical diagnosis of pheochromocytoma: which test is best? J. Am. Med. Assoc. 2002; 287: 1427–1434.CrossRefGoogle ScholarPubMed
Pacak, K., Linehan, W. M., Eisenhofer, G., Walther, M. M., & Goldstein, D. S.Recent advances in genetics, diagnosis, localization, and treatment of pheochromocytoma. Ann. Intern. Med. 2001; 134: 315–329.CrossRefGoogle ScholarPubMed
Kinney, M. A., Narr, B. J., & Warner, M. A.Perioperative management of pheochromocytoma. J. Cardiothorac. Vasc. Anesth. 2002; 16: 359–369.CrossRefGoogle ScholarPubMed
Crandell, D.The anesthetic hazards in patients on antihypertensive therapy. J. Am. Med. Assoc. 1961; 179: 495–500.CrossRefGoogle Scholar
Katz, J. D., Croneau, L. H., & Barash, P. G.Postoperative hypertension: a hazard of abrupt cessation of antihypertensive medication in the preoperative period. Am. Heart J. 1976; 92: 79–80.CrossRefGoogle ScholarPubMed
Bruce, D. L., Croley, T. F., & Lee, J. S.Preoperative clonidine withdrawal syndrome. Anesthesiology 1979; 51: 90–92.CrossRefGoogle ScholarPubMed
Houston, M. C.Abrupt cessation of treatment in hypertension: consideration of clinical features, mechanisms, prevention and management of the discontinuation syndrome. Am. Heart J. 1981; 102: 415–430.CrossRefGoogle ScholarPubMed
Brodsky, J. B. & Bravo, J. J.Acute postoperative clonidine withdrawal syndrome. Anesthesiology 1976; 44: 519–520.Google ScholarPubMed
Prys-Roberts, C.Interactions of anaesthesia and high pre-operative doses of beta-receptor antagonists. Acta Anaesthesiol. Scand. Suppl. 1982; 76: 47–53.CrossRefGoogle ScholarPubMed
Prys-Roberts, C., Foex, P., Biro, G. P., & Roberts, J. G.Studies of anaesthesia in relation to hypertension. V. Adrenergic beta-receptor blockade. Br. J. Anaesth. 1973; 45: 671–681.CrossRefGoogle ScholarPubMed
Ferguson, T. B. Jr., Coombs, L. P., & Peterson, E. D.Preoperative beta-blocker use and mortality and morbidity following CABG surgery in North America. J. Am. Med. Assoc. 2002; 287: 2221–2227.CrossRefGoogle ScholarPubMed
Mangano, D. T., Layug, E. L., Wallace, A., & Tateo, I.Effect of atenolol on mortality and cardiovascular morbidity after noncardiac surgery. Multicenter Study of Perioperative Ischemia Research Group. N. Engl. J. Med. 1996; 335: 1713–1720.CrossRefGoogle ScholarPubMed
Magnusson, J., Thulin, T., Werner, O., Jarhult, J., & Thomson, D.Haemodynamic effects of pretreatment with metoprolol in hypertensive patients undergoing surgery. Br. J. Anaesth. 1986; 58: 251–260.CrossRefGoogle ScholarPubMed
Pasternack, P. F., Grossi, E. A., Baumann, F. G.et al. Beta blockade to decrease silent myocardial ischemia during peripheral vascular surgery. Am. J. Surg. 1989; 158: 113–116.CrossRefGoogle ScholarPubMed
Poldermans, D., Boersma, E., Bax, J. J., et al. Bisoprolol reduces cardiac death and myocardial infarction in high-risk patients as long as 2 years after successful major vascular surgery. Eur. Heart J. 2001; 22: 1353–1358.CrossRefGoogle Scholar
Poldermans, D., Boersma, E., Bax, J. J.et al. The effect of bisoprolol on perioperative mortality and myocardial infarction in high-risk patients undergoing vascular surgery. Dutch Echocardiographic Cardiac Risk Evaluation Applying Stress Echocardiography Study Group. N. Engl. J. Med. 1999; 341: 1789–1794.CrossRefGoogle ScholarPubMed
Low, J. M., Harvey, J. T., Prys-Roberts, C., & Dagnino, J.Studies of anaesthesia in relation to hypertension. VII: Adrenergic responses to laryngoscopy. Br. J. Anaesth. 1986; 58: 471–477.CrossRefGoogle ScholarPubMed
Goldman, L.Noncardiac surgery in patients receiving propranolol. Case reports and recommended approach. Arch. Intern. Med. 1981; 141: 193–196.CrossRefGoogle ScholarPubMed
Hart, G. R. & Anderson, R. J.Withdrawal syndromes and the cessation of antihypertensive therapy. Arch. Intern. Med. 1981; 141: 1125–1127.CrossRefGoogle ScholarPubMed
Shammash, J. B., Trost, J. C., Gold, J. M., Berlin, J. A., Golden, M. A., & Kimmel, S. E.Perioperative beta-blocker withdrawal and mortality in vascular surgical patients. Am. Heart J. 2001; 141: 148–153.CrossRefGoogle ScholarPubMed
Psaty, B. M., Koepsell, T. D., Wagner, E. H., LoGerfo, J. P., & Inui, T. S.The relative risk of incident coronary heart disease associated with recently stopping the use of beta-blockers. J. Am. Med. Assoc. 1990; 263: 1653–1657.CrossRefGoogle ScholarPubMed
Buggy, D., Higgins, P., Moran, C., O'Donovan, F., & McCarroll, M.Clonidine at induction reduces shivering after general anaesthesia. Can. J. Anaesth. 1997; 44: 263–267.CrossRefGoogle ScholarPubMed
Dorman, B. H., Zucker, J. R., Verrier, E. D., Gartman, D. M., & Slachman, F. N.Clonidine improves perioperative myocardial ischemia, reduces anesthetic requirement, and alters hemodynamic parameters in patients undergoing coronary artery bypass surgery. J. Cardiothorac. Vasc. Anesth. 1993; 7: 386–395.CrossRefGoogle ScholarPubMed
Dorman, T., Clarkson, K., Rosenfeld, B. A., Shanholtz, C., Lipsett, P. A., & Breslow, M. J.Effects of clonidine on prolonged postoperative sympathetic response. Crit. Care Med. 1997; 25: 1147–1152.CrossRefGoogle ScholarPubMed
Ellis, J. E., Drijvers, G., Pedlow, S.et al. Premedication with oral and transdermal clonidine provides safe and efficacious postoperative sympatholysis. Anesth. Analg. 1994; 79: 1133–1140.CrossRefGoogle ScholarPubMed
Goyagi, T., Tanaka, M., & Nishikawa, T.Oral clonidine premedication reduces induction dose and prolongs awakening time from propofol-nitrous oxide anesthesia. Can. J. Anaesth. 1999; 46: 894–896.CrossRefGoogle ScholarPubMed
Howie, M. B., Hiestand, D. C., Jopling, M. W., Romanelli, V. A., Kelly, W. B., & McSweeney, T. D.Effect of oral clonidine premedication on anesthetic requirement, hormonal response, hemodynamics, and recovery in coronary artery bypass graft surgery patients. J. Clin. Anesth. 1996; 8: 263–272.CrossRefGoogle ScholarPubMed
Stuhmeier, K. D., Mainzer, B., Cierpka, J., Sandmann, W., & Tarnow, J.Small, oral dose of clonidine reduces the incidence of intraoperative myocardial ischemia in patients having vascular surgery. Anesthesiology 1996; 85: 706–712.CrossRefGoogle ScholarPubMed
Zalunardo, M. P., Zollinger, A., Spahn, D. R., Seifert, B., & Pasch, T.Preoperative clonidine attenuates stress response during emergence from anesthesia. J. Clin. Anesth. 2000; 12: 343–349.CrossRefGoogle ScholarPubMed
Goyagi, T., Tanaka, M., & Nishikawa, T.Oral clonidine premedication reduces the awakening concentration of isoflurane. Anesth. Analg. 1998; 86: 410–413.Google ScholarPubMed
Bellaiche, S., Bonnet, F., Sperandio, M., Lerouge, P., Cannet, G., & Roujas, F.Clonidine does not delay recovery from anaesthesia. Br. J. Anaesth. 1991; 66: 353–357.CrossRefGoogle Scholar
Higuchi, H., Adachi, Y., Arimura, S., Ogata, M., & Satoh, T.Oral clonidine premedication reduces the awakening concentration of propofol. Anesth. Analg. 2002; 94: 609–614; table of contents.CrossRefGoogle ScholarPubMed
O'Connor, D. E.Accelerated acute clonidine withdrawal syndrome during coronary artery bypass surgery. A case report. Br. J. Anaesth. 1981; 53: 431–433.CrossRefGoogle ScholarPubMed
Kaukinen, S., Kaukinen, L., & Eerola, R.Preoperative and postoperative use of clonidine with neurolept anaesthesia. Acta Anaesthesiol. Scand. 1979; 23: 113–120.CrossRefGoogle ScholarPubMed
Schmidt, G. R. & Schuna, A. A.Rebound hypertension after discontinuation of transdermal clonidine. Clin. Pharm. 1988; 7: 772–774.Google ScholarPubMed
Bernstein, J. S.Transdermal clonidine therapy for the perioperative period. Anesthesiology 1986; 65: 451.CrossRefGoogle ScholarPubMed
Johnston, R. V., Nicholas, D. A., Lawson, N. W., & Wallfisch, H. K., Arens, J. F.The use of rectal clonidine in the perioperative period. Anesthesiology 1986; 64: 288–290.CrossRefGoogle ScholarPubMed
Coriat, P., Richer, C., Douraki, T.et al. Influence of chronic angiotensin-converting enzyme inhibition on anesthetic induction. Anesthesiology 1994; 81: 299–307.CrossRefGoogle ScholarPubMed
Colson, P., Saussine, M., Seguin, J. R., Cuchet, D., Chaptal, P. A., & Roquefeuil, B.Hemodynamic effects of anesthesia in patients chronically treated with angiotensin-converting enzyme inhibitors. Anesth. Analg. 1992; 74: 805–808.CrossRefGoogle ScholarPubMed
Ryckwaert, F. & Colson, P.Hemodynamic effects of anesthesia in patients with ischemic heart failure chronically treated with angiotensin-converting enzyme inhibitors. Anesth. Analg. 1997; 84: 945–949.CrossRefGoogle ScholarPubMed
Kataja, J. H., Kaukinen, S., Viinamaki, O. V., Metsa-Ketela, T. J., & Vapaatalo, H.Hemodynamic and hormonal changes in patients pretreated with captopril for surgery of the abdominal aorta. J. Cardiothorac. Anesth. 1989; 3: 425–432.CrossRefGoogle ScholarPubMed
McCarthy, G. J., Hainsworth, M., Lindsay, K., Wright, J. M., & Brown, T. A.Pressor responses to tracheal intubation after sublingual captopril. A pilot study. Anaesthesia 1990; 45: 243–245.CrossRefGoogle ScholarPubMed
Yates, A. P. & Hunter, D. N.Anaesthesia and angiotensin-converting enzyme inhibitors. The effect of enalapril on peri-operative cardiovascular stability. Anaesthesia 1988; 43: 935–938.CrossRefGoogle ScholarPubMed
Tuman, K. J., McCarthy, R. J., O'Connor, C. J., Holm, W. E., & Ivankovich, A. D.Angiotensin-converting enzyme inhibitors increase vasoconstrictor requirements after cardiopulmonary bypass. Anesth. Analg. 1995; 80: 473–479.CrossRefGoogle ScholarPubMed
Pigott, D. W., Nagle, C., Allman, K., Westaby, S., & Evans, R. D.Effect of omitting regular ACE inhibitor medication before cardiac surgery on haemodynamic variables and vasoactive drug requirements. Br. J. Anaesth. 1999; 83: 715–720.CrossRefGoogle ScholarPubMed
Brabant, S. M., Bertrand, M., Eyraud, D., Darmon, P. L., & Coriat, P.The hemodynamic effects of anesthetic induction in vascular surgical patients chronically treated with angiotensin II receptor antagonists. Anesth. Analg. 1999; 89: 1388–1392.Google ScholarPubMed
Bertrand, M., Godet, G., Meersschaert, K., Brun, L., Salcedo, E., & Coriat, P.Should the angiotensin II antagonists be discontinued before surgery? Anesth. Analg. 2001; 92: 26–30.CrossRefGoogle ScholarPubMed
Gottlieb, S. O., Ouyang, P., Achuff, S. C.et al. Acute nifedipine withdrawal: consequences of preoperative and late cessation of therapy in patients with prior unstable angina. J. Am. Coll. Cardiol. 1984; 4: 382–388.CrossRefGoogle ScholarPubMed
Engelman, R. M., Hadji-Rousou, I., Breyer, R. H., Whittredge, P., Harbison, W., & Chircop, R. V.Rebound vasospasm after coronary revascularization in association with calcium antagonist withdrawal. Ann. Thorac. Surg. 1984; 37: 469–472.CrossRefGoogle ScholarPubMed
Subramanian, V. B., Bowles, M. J., Khurmi, N. S., Davies, A. B., O'Hara, M. J., & Raftery, E. B.Calcium antagonist withdrawal syndrome: objective demonstration with frequency-modulated ambulatory ST-segment monitoring. Br. Med. J. (Clin. Res. Ed) 1983; 286: 520–521.CrossRefGoogle ScholarPubMed
Zuccala, G., Pahor, M., Landi, F.et al. Use of calcium antagonists and need for perioperative transfusion in older patients with hip fracture: observational study. BMJ 1997; 314: 643–644.CrossRefGoogle ScholarPubMed
Mychaskiw, G., 2nd, Hoehner, P., Abdel-Aziz, A.et al. Preoperative exposure to calcium channel blockers suggests increased blood product use following cardiac surgery. J. Miss. State Med. Assoc. 2000; 41: 752–756.Google ScholarPubMed
Makker, S. P. & Moorthy, B.Rebound hypertension following minoxidil withdrawal. J. Pediatr. 1980; 96: 762–766.CrossRefGoogle ScholarPubMed
Psaty, B. M., Smith, N. L., Siscovick, D. S.et al. Health outcomes associated with antihypertensive therapies used as first-line agents. A systematic review and meta-analysis. J. Am. Med. Assoc. 1997; 277: 739–745.CrossRefGoogle ScholarPubMed
Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs diuretic: The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). J. Am. Med. Assoc. 2002; 288: 2981–2997.CrossRef
Raby, K. E., Brull, S. J., Timimi, F.et al. The effect of heart rate control on myocardial ischemia among high-risk patients after vascular surgery. Anesth. Analg. 1999; 88: 477–482.CrossRefGoogle ScholarPubMed
Wallace, A., Layug, B., Tateo, I.et al. Prophylactic atenolol reduces postoperative myocardial ischemia. McSPI Research Group. Anesthesiology 1998; 88: 7–17.CrossRefGoogle ScholarPubMed
Urban, M. K., Markowitz, S. M., Gordon, M. A., Urquhart, B. L., & Kligfield, P.Postoperative prophylactic administration of beta-adrenergic blockers in patients at risk for myocardial ischemia. Anesth. Analg. 2000; 90: 1257–1261.CrossRefGoogle ScholarPubMed
Auerbach, A. D., & Goldman, L.Beta-blockers and reduction of cardiac events in noncardiac surgery: scientific review. J. Am. Med. Assoc. 2002; 287: 1435–1444.Google ScholarPubMed
Gal, T. J. & Cooperman, L. H.Hypertension in the immediate postoperative period. Br. J. Anaesth. 1975; 47: 70–74.CrossRefGoogle ScholarPubMed
Patel, C. B., Laboy, V., Venus, B., Mathru, M., & Wier, D.Use of sodium nitroprusside in post-coronary bypass surgery. A plea for conservatism. Chest 1986; 89: 663–667.CrossRefGoogle ScholarPubMed
Chauvin, M., Deriaz, H., & Viars, P.Continuous i.v. infusion of labetalol for postoperative hypertension. Haemodynamic effects and plasma kinetics. Br. J. Anaesth. 1987; 59: 1250–1256.CrossRefGoogle ScholarPubMed
Cosentino, F., Vidt, D. G., Orlowski, J. P., Shiesley, D., & Little, J. R.The safety of cumulative doses of labetalol in perioperative hypertension. Cleve. Clin. J. Med. 1989; 56: 371–376.CrossRefGoogle ScholarPubMed
Cruise, C. J., Skrobik, Y., Webster, R. E., Marquez-Julio, A., & David, T. E.Intravenous labetalol versus sodium nitroprusside for treatment of hypertension postcoronary bypass surgery. Anesthesiology 1989; 71: 835–839.CrossRefGoogle ScholarPubMed
Dimich, I., Lingham, R., Gabrielson, G., Singh, P. P., & Kaplan, J. A.Comparative hemodynamic effects of labetalol and hydralazine in the treatment of postoperative hypertension. J. Clin. Anesth. 1989; 1: 201–206.CrossRefGoogle ScholarPubMed
Geniton, D. J.A comparison of the hemodynamic effects of labetalol and sodium nitroprusside in patients undergoing carotid endarterectomy. AANA J. 1990; 58: 281–287.Google ScholarPubMed
Kross, R. A., Ferri, E., Leung, D.et al. A comparative study between a calcium channel blocker (Nicardipine) and a combined alpha-beta-blocker (Labetalol) for the control of emergence hypertension during craniotomy for tumor surgery. Anesth. Analg. 2000; 91: 904–909.CrossRefGoogle Scholar
Leslie, J. B., Kalayjian, R. W., Sirgo, M. A., Plachetka, J. R., & Watkins, W. D.Intravenous labetalol for treatment of postoperative hypertension. Anesthesiology 1987; 67: 413–416.CrossRefGoogle ScholarPubMed
Malsch, E., Katonah, J., Gratz, I., & Scott, A.The effectiveness of labetalol in treating postoperative hypertension. Nurse Anesth. 1991; 2: 65–71.Google ScholarPubMed
Muzzi, D. A., Black, S., Losasso, T. J., & Cucchiara, R. F.Labetalol and esmolol in the control of hypertension after intracranial surgery. Anesth. Analg. 1990; 70: 68–71.CrossRefGoogle ScholarPubMed
Orlowski, J. P., Shiesley, D., Vidt, D. G., Barnett, G. H., & Little, J. R.Labetalol to control blood pressure after cerebrovascular surgery. Crit. Care Med. 1988; 16: 765–768.CrossRefGoogle ScholarPubMed
Orlowski, J. P., Vidt, D. G., Walker, S., & Haluska, J. F.The hemodynamic effects of intravenous labetalol for postoperative hypertension. Cleve Clin. J. Med. 1989; 56: 29–34.CrossRefGoogle ScholarPubMed
Prys-Roberts, C. & Dagnino, J.Continuous i.v. infusion of labetalol for postoperative hypertension. Br. J. Anaesth. 1988; 60: 600.CrossRefGoogle ScholarPubMed
Singh, P. P., Dimich, I., Sampson, I., & Sonnenklar, N.A comparison of esmolol and labetalol for the treatment of perioperative hypertension in geriatric ambulatory surgical patients. Can. J. Anaesth. 1992; 39: 559–562.CrossRefGoogle ScholarPubMed
Arthur, S. & Greenberg, A.Hyperkalemia associated with intravenous labetalol therapy for acute hypertension in renal transplant recipients. Clin. Nephrol. 1990; 33: 269–271.Google ScholarPubMed
McCauley, J., Murray, J., Jordan, M., Scantlebury, V., Vivas, C., & Shapiro, R.Labetalol-induced hyperkalemia in renal transplant recipients. Am. J. Nephrol. 2002; 22: 347–351.CrossRefGoogle ScholarPubMed
Hamad, A., Salameh, M., Zihlif, M., Feinfeld, D. A., & Carvounis, C. P.Life-threatening hyperkalemia after intravenous labetalol injection for hypertensive emergency in a hemodialysis patient. Am. J. Nephrol. 2001; 21: 241–244.CrossRefGoogle Scholar
Gibson, B. E., Black, S., Maass, L., & Cucchiara, R. F.Esmolol for the control of hypertension after neurologic surgery. Clin. Pharmacol. Ther. 1988; 44: 650–653.CrossRefGoogle ScholarPubMed
Gray, R. J., Bateman, T. M., Czer, L. S., Conklin, C., & Matloff, J. M.Comparison of esmolol and nitroprusside for acute post-cardiac surgical hypertension. Am. J. Cardiol. 1987; 59: 887–891.CrossRefGoogle ScholarPubMed
Murphy, M. B., Murray, C., & Shorten, G. D.Fenoldopam: a selective peripheral dopamine-receptor agonist for the treatment of severe hypertension. N. Engl. J. Med. 2001; 345: 1548–1557.CrossRefGoogle ScholarPubMed
Shusterman, N. H., Elliott, W. J., & White, W. B.Fenoldopam, but not nitroprusside, improves renal function in severely hypertensive patients with impaired renal function. Am. J. Med. 1993; 95: 161–168.CrossRefGoogle Scholar
Elliott, W. J., Weber, R. R., Nelson, K. S.et al. Renal and hemodynamic effects of intravenous fenoldopam versus nitroprusside in severe hypertension. Circulation 1990; 81: 970–977.CrossRefGoogle ScholarPubMed
Goldberg, M. E., Clark, S., Joseph, J.et al. Nicardipine versus placebo for the treatment of postoperative hypertension. Am. Heart J. 1990; 119: 446–450.CrossRefGoogle ScholarPubMed
Efficacy and safety of intravenous nicardipine in the control of postoperative hypertension. IV Nicardipine Study Group. Chest 1991; 99: 393–398.CrossRef
Halpern, N. A., Alicea, M., Krakoff, L. R., & Greenstein, R.Postoperative hypertension: a prospective, placebo-controlled, randomized, double-blind trial, with intravenous nicardipine hydrochloride. Angiology 1990; 41: 992–1004.Google ScholarPubMed
Halpern, N. A., Sladen, R. N., Goldberg, J. S.et al. Nicardipine infusion for postoperative hypertension after surgery of the head and neck. Crit. Care Med. 1990; 18: 950–955.CrossRefGoogle ScholarPubMed
Wezel, H. B., Koolen, J. J., Visser, C. A.et al. Antihypertensive and anti-ischemic effects of nicardipine and nitroprusside in patients undergoing coronary artery bypass grafting. Am. J. Cardiol. 1989; 64: 22H–27H.CrossRefGoogle ScholarPubMed
Vincent, J. L., Berlot, G., Preiser, J. C., Engelman, E., Dereume, J. P., & Khan, R. J.Intravenous nicardipine in the treatment of postoperative arterial hypertension. J. Cardiothorac. Vasc. Anesth. 1997; 11: 160–164.CrossRefGoogle ScholarPubMed
Grossman, E., Messerli, F. H., Grodzicki, T., & Kowey, P.Should a moratorium be placed on sublingual nifedipine capsules given for hypertensive emergencies and pseudoemergencies? J. Am. Med. Assoc. 1996; 276: 1328–1331.CrossRefGoogle ScholarPubMed
Basali, A., Mascha, E. J., Kalfas, I., & Schubert, A.Relation between perioperative hypertension and intracranial hemorrhage after craniotomy. Anesthesiology 2000; 93: 48–54.CrossRefGoogle ScholarPubMed
Aken, H., Cottrell, J. E., Anger, C., & Puchstein, C.Treatment of intraoperative hypertensive emergencies in patients with intracranial disease. Am. J. Cardiol. 1989; 63: 43C–47C.CrossRefGoogle ScholarPubMed
Tohmo, H. & Karanko, M.Enalaprilat controls postoperative hypertension while maintaining cardiac function and systemic oxygenation after neurosurgery. Intens. Care Med. 1995; 21: 651–656.CrossRefGoogle ScholarPubMed
Wood, G.Effect of antihypertensive agents on the arterial partial pressure of oxygen and venous admixture after cardiac surgery. Crit. Care Med. 1997; 25: 1807–1812.CrossRefGoogle ScholarPubMed
Asiddao, C. B., Donegan, J. H., Whitesell, R. C., & Kalbfleisch, J. H.Factors associated with perioperative complications during carotid endarterectomy. Anesth. Analg. 1982; 61: 631–637.CrossRefGoogle ScholarPubMed
Towne, J. B. & Bernhard, V. M.The relationship of postoperative hypertension to complications following carotid endarterectomy. Surgery 1980; 88: 575–580.Google ScholarPubMed
Lehv, M. S., Salzman, E. W., & Silen, W.Hypertension complicating carotid endarterectomy. Stroke 1970; 1: 307–313.CrossRefGoogle ScholarPubMed
Hans, S. S., & Glover, J. L.The relationship of cardiac and neurological complications to blood pressure changes following carotid endarterectomy. Am. Surg. 1995; 61: 356–359.Google ScholarPubMed
Wong, J. H., Findlay, J. M., & Suarez-Almazor, M. E.Hemodynamic instability after carotid endarterectomy: risk factors and associations with operative complications. Neurosurgery 1997; 41: 35–41; discussion 41–43.CrossRefGoogle ScholarPubMed
Dorman, T., Thompson, D. A., Breslow, M. J., Lipsett, P. A., & Rosenfeld, B. A.Nicardipine versus nitroprusside for breakthrough hypertension following carotid endarterectomy. J. Clin. Anesth. 2001; 13: 16–19.CrossRefGoogle ScholarPubMed
Skudlarick, J. L. & Mooring, S. L.Systolic hypertension and complications of carotid endarterectomy. South Med. J. 1982; 75: 1563–1565, 1567.CrossRefGoogle ScholarPubMed

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