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고혈압 환자의 마취관리

Anesthetic management of hypertensive patients

대한의사협회지 2020년 63권 9호 p.519 ~ 525
김덕경,
소속 상세정보
김덕경 ( Kim Duk-Kyung ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Anesthesiology and Pain Medicine

Abstract


It is important for the clinicians to have a clear understanding of the anesthetic implications and increased risks due to hypertension to ensure safe surgical procedures in hypertensive patients. Preoperative hypertension is associated with greater intraoperative hemodynamic lability and an increased risk of perioperative cardiovascular complications. In addition to the patients’ baseline blood pressure (BP), the presence and severity of target organ damage and cardiovascular comorbidities should be evaluated preoperatively. Delaying surgery in hypertensive patients may be justified if there is an evidence of target organ damage that can be improved by such a delay. Further evaluation of suspected target organ damage before the surgery is also justified. Except withholding angiotensinconverting enzyme inhibitors/angiotensin receptor blockers 10 to 24 hours before the surgery, the continuation of preoperative antihypertensive therapy is generally recommended. Though maintaining perioperative BP within the range of 80%?90% to 110%?120% of the baseline BP (permissible BP decrease/increase ≤10%?20%) is generally recommended, an individualized and pathophysiology-based approach to control BP might be the best option throughout the perioperative period. In other words, BP targets in the perioperative period should be determined based on the type of surgery, patients’ baseline BP, risks of hypotension-related organ ischemia, and hypertension-related bleeding.

키워드

마취;고혈압;항고혈압제;합병증;수술전후기
Anesthesia; Hypertension; Antihypertensive agents; Complications; Perioperative period

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