Document Detail


Association of preanesthesia hypertension with adverse outcomes.
MedLine Citation:
PMID:  20817562     Owner:  NLM     Status:  In-Process    
Abstract/OtherAbstract:
OBJECTIVE: To investigate the incidence of preanesthesia hypertension, case cancellation for hypertension, and association with postoperative outcomes.
DESIGN: Retrospective descriptive, univariate, and multivariate analyses of electronic anesthesia and hospital records.
SETTING: A large urban academic medical center.
PARTICIPANTS: Adult elective surgical patients with preinduction blood pressure (BP) >140/90 mmHg during calendar years 2002 to 2008.
INTERVENTIONS: None.
MEASUREMENTS AND MAIN RESULTS: Preinduction hypertension was present in 21,126 of 209,985 (10%) patients, and the incidence of adverse outcomes (elevated troponin or in-hospital death) was 1.3% overall and 2.8% for the subset of patients with baseline systolic BP >200 mmHg. Independent predictors of adverse outcome included increased baseline systolic BP, intraoperative diastolic BP <85 mmHg, increased intraoperative heart rate, blood transfusion, and anesthetic technique, controlling for standard risk factors. A total of 69 hypertensive patients (0.3%) had surgery cancelled before the induction of anesthesia; 29 of these cancellations occurred among the 1,330 patients with baseline SBP >200 mmHg (2.2%). Among 42 "cancelled" patients who returned for surgery hours to years later, the average preinduction BP was 192/102 mmHg, and adverse cardiovascular outcomes occurred in 4.8%.
CONCLUSIONS: The increasing severity of preinduction hypertension was an independent risk factor for postoperative myocardial injury/infarction or in-hospital death. Only a small percentage of cases with patients presenting with severe hypertension were cancelled, and the delay of surgery did not result in interval normalization of blood pressure.
Authors:
David B Wax; Steven B Porter; Hung-Mo Lin; Sabera Hossain; David L Reich
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of cardiothoracic and vascular anesthesia     Volume:  24     ISSN:  1532-8422     ISO Abbreviation:  J. Cardiothorac. Vasc. Anesth.     Publication Date:  2010 Dec 
Date Detail:
Created Date:  2010-11-26     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9110208     Medline TA:  J Cardiothorac Vasc Anesth     Country:  United States    
Other Details:
Languages:  eng     Pagination:  927-30     Citation Subset:  IM    
Copyright Information:
Copyright © 2010 Elsevier Inc. All rights reserved.
Affiliation:
Department of Anesthesiology, Mount Sinai School of Medicine, New York, NY 10029, USA.david.wax@mssm.edu
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