Hipertansiyon ve Anestezi
Synopsis
Hypertension (HT) is the persistent elevation of blood pressure against arterial walls and is categorized as primary or secondary. Blood pressure regulation is mediated by sodium levels, the renin-angiotensin-aldosterone system (RAAS), natriuretic peptides, endothelial function, the sympathetic nervous system, and immune system mechanisms. Diagnosed through clinical and out-of-office blood pressure measurements, hypertension management encompasses lifestyle modifications and pharmacotherapeutic agents such as ACE inhibitors, ARBs, calcium channel blockers, thiazide diuretics, and beta-blockers. Hypertension is a major determinant of perioperative risk in surgical settings; specifically, a preoperative diastolic blood pressure exceeding 110 mmHg increases the risk of myocardial ischemia, dysrhythmias, and renal failure. During preoperative evaluation, ACE inhibitors and ARBs are discontinued 24 hours prior to surgery to mitigate intraoperative hypotension, whereas beta-blockers and centrally acting sympathomimetics must be continued due to the risk of rebound hypertension. Intraoperatively, target blood pressure should remain within 20% of baseline values, maintaining a mean arterial pressure above 65 mmHg. Intraoperative hypertension can stem from light anesthesia, intubation, hypoxemia, hypervolemia, or drug withdrawal, and is managed using beta-blockers, calcium channel blockers, and direct vasodilators. Conversely, intraoperative hypotension is treated with fluid replacement and vasopressors. In cases of postoperative hypertension within the PACU, triggers such as pain, hypercapnia, and agitation are controlled alongside appropriate antihypertensive therapy.
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