Perioperative blood pressure control in hypertensive and normotensive patients undergoing off-pump coronary artery bypass grafting: prospective study of current anesthesia practice

Barišin, Stjepan and Šakić, Kata and Goranović, Tatjana and Barišin, Ana and Sonicki, Zdenko (2007) Perioperative blood pressure control in hypertensive and normotensive patients undergoing off-pump coronary artery bypass grafting: prospective study of current anesthesia practice. Croatian Medical Journal, 48 (3). pp. 341-347. ISSN 0353-9504

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Abstract

Aim. To analyze blood pressure changes during intra- and immediate postoperative period in patients undergoing off-pump coronary artery bypass grafting. ----- Methods. The study included 355 consecutive patients undergoing off-pump coronary artery bypass grafting between January 5, 2004 and December 30, 2005. Out of these patients, 325 were allocated into groups with preoperative history of hypertension (n=115) and without preoperative history of hypertension (n=210). Systolic, diastolic, and mean arterial blood pressure was measured at the following four time points: on the day before surgery, before anesthesia induction, after the last graft, and on entry to intensive care unit. ----- Results. Mean arterial pressure was significantly higher in patients with a history of hypertension on the day before surgery (97 vs 92 mm Hg, P=0.003, Mann-Whitney test) and before anesthesia induction (107 vs 98 mm Hg; P=0.003). It was higher at all measuring points (after the last graft, 79 vs 78 mm Hg; and on entry to intensive care unit, 88 vs 86 mm Hg), but this difference was neither statistically nor clinically significant. The study showed that mean arterial pressure followed similar dynamics over time in both patient groups (P<0.001 both), with no significant time-dependent between-group differences. ----- Conclusion. Current anesthesia techniques that include deep opioid analgesia in combination with vasodilators provide a satisfactory control of intraoperative hypertension. Management of blood pressure changes during intra- and immediate postoperative period in off-pump coronary artery bypass grafting patients with preoperative hypertension was no more difficult than in patients without preoperative hypertension.

Abstract in Croatian

(Nadzor perioperativnoga krvnoga tlaka u hipertenzivnih i normotenzivnih bolesnika prilikom presađivanja prjemosnice koronarne arterije bez uporabe izvantjelesne crpke: prospektivna analiza primijenjene anesteziološke prakse) ----- Cilj: Analizirati promjene krvnoga tlaka za vrijeme operacije i neposredno poslije nje u bolesnika u kojih je presađena prjemosnica koronarne arterije bez uporabe izvantjelesne crpke. ----- Postupci: Istraživanje je obuhvatilo 355 bolesnika kojima je susljedno presađena prjemosnica koronarne arterije bez uporabe izvantjelesne crpke između 5. siječnja 2004. i 30. prosinca 2005. Od tih bolesnika, 115 je imalo a 210 nije imalo preoperativnu hipertenziju. Mjereni su sistolički, dijastolički i srednji arterijski tlak u četiri vremenske točke: jedan dan prije operacije, prije uvođenja u anesteziju, poslije postavljanja zadnjega presatka i pri ulasku u jedinicu intenzivne skrbi. ----- Rezultati: U bolesnika koji su u povijesti bolesti imali hipertenziju, srednji arterijski tlak bio je značajno viši jedan dan prije operacije (97 vs 92 mmHg, P=0,003, Mann Whitneyov test) i prije uvođenja u anesteziju (107 vs 98 mmHg; P=0,003, Mann-Whitneyov test). Tlak im je bio viši i na ostalim točkama mjerenja (nakon postavljanja zadnjega presatka, 79 vs 78 mmHg; i pri ulasku u jedinicu intenzivne skrbi, 88 vs 86 mmHg), ali razlika nije bila ni statistički ni klinički značajna. U svim točkama mjerenja promjene srednjega arterijskog tlaka bile su slične u obje skupine bolesnika (P<0,001 za obje skupine), ali između skupina nije bilo razlika. ----- Zaključak: Primijenjene anesteziološke tehnike, koje uključuju duboku analgeziju opioidima združenu s vazodilatatorima, omogućuju zadovoljavajući nadzor intraoperacijske hipertenzije. Nadzor nad promjenama krvnoga tlaka za vrijeme operacije i neposredno nakon nje u bolesnika s povišenim krvnim tlakom u kojih se presađuje prjemosnica koronarne arterije bez uporabe izvantjelesne crpke nije teži nego li u bolesnika u kojih krvni tlak nije povišen.

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