Cardiovascular Response during Induction, Laryngoscopy, Intubation and Surgery in Normotensive and Controlled Hypertensive Patients Undergoing Abdominal Surgeries under General Anaesthesia

Introduction: Hypertension is very common conditionamong adult and elderly patients. Ii is one of the importantrisk factor of atherosclerosis of vessels. Anesthetist’s morecommonly tackle the management of treated and untreatedhypertensive patients. The considerable concern of anaesthtistnot only strong association with coronary artery disease butpotential target organ damage. This study was conducted toassess cardiovascular response in different stages of generalanesthesia in abdominal surgeries.Material and methods: Sixty adult patients undergoingdifferent elective abdominal operations under generalanesthesia were included. Patients were divided into A andB group. A group consists of normotensive patients while Bgroup consists of controlled hypertensive patients. Their bloodpressure were controlled on single antihypertensive drug.B group further divided into B1 and B2. B1 group patientswere on beta blockers (BB) while B2 group patients were onangiotensin converting enzyme inhibitors(ACEI).Results: There was decrease in SAP, DP and HR in all groupsafter induction while there was increase in SAP, DP and HRin all groups after laryngoscopy and intubation. There wasminimal rise in SAP, DP and HR in all groups during surgery.The rise of HR was comparatively less in BB group thanACEI group during laryngoscopy and intubation while rise inSAP was comparatively more in ACEI than BB group duringsurgery.Conclusion: On the basis of the present observation it canbe concluded that pressure response and cardiac response(cardiovascular response) to laryngoscopy and intubationappears to be unaffected with these antihypertensive drugs.

Hypertension in Tunisian adults attending primary care physicians (ETHNA-Tunisia)

The aim of the Epidemiological Trial of Hypertension in North Africa (ETHNA-Tunisia) was to evaluate the prevalence and clinical profile of hypertension in a large sample of individuals in Tunisia. This was multicenter, epidemiological, cross-sectional study conducted in patients consulting primary care physicians in Tunisia. Mean age of 5802 individuals was 49.6 ± 16.3 years. The total prevalence of hypertension was 47.4% (adjusted for age: 26.9%). Control of hypertension was only 37.1%. Hypertension may also be underdiagnosed and ineffectively treated. Greater awareness and improved management of hypertension and cardiovascular risks are needed in Tunisia.

Evaluation of haemodynamic changes in hypertensive patients during tooth extraction under local anaesthesia / Evaluación de los cambios hemodinámicos en pacientes hipertensos durante la extracción dental con anestesia local

OBJECTIVES: This study was conducted to determine the changes in blood pressure and the pulse rate of patients with controlled hypertension having dental extraction under local anaesthesia utilizing 2% lignocaine with adrenaline, and to evaluate whether these changes in blood pressure were are attributable to addition of adrenaline. METHODS: This prospective study was carried out in 33 consecutive hypertensive patients who presented at the exodontia clinic of the Department of Oral and Maxillofacial Surgery, Lagos University Teaching Hospital (LUTH), Idi-Araba, Lagos, from December 2004 to August 2005 for intra-alveolar tooth extraction. Patients were randomly allocated to two groups according to the type of anaesthetic solution employed. Group A had tooth extraction done under 2% lignocaine with 1:80 000 adrenaline while group B had tooth extraction done under 2% lignocaine without vasoconstrictor (plain lignocaine). One tooth was extracted from each patient. Blood pressure and pulse rate measurements were recorded in the waiting room before surgery, in the surgery after local anaesthetic injection, during tooth extraction and 15 minutes after tooth extraction. RESULTS: The sample consisted of 20 females and 13 males age range 24 to 75 years (mean ± SD = 50.1 ± 11.7 years). There was no statistically significant difference between the systolic and diastolic blood pressure and pulse rate in the two groups after administration oflocal anaesthesia. However, the highest alteration in parameters was observed during tooth extraction in the two groups. CONCLUSION: The haemodynamic changes induced by injecting 2% lignocaine with adrenaline in patients with controlled hypertension during tooth extraction is within normal range and is not different from that induced by 2% lignocaine without adrenaline. We consider it essential that all precautions to prevent inadvertent intravascular injection be undertaken by the care provider.

OBJETIVO: Este estudio fue dirigido para determinar los cambios en la tensión arterial y la tasa de pulso de pacientes con hipertensión controlada, a quienes se les realiza una extracción dental bajo las condiciones de la anestesia local, utilizando lidocaína al 2% con adrenalina, y evaluar si estos cambios en la tensión arterial eran atribuibles a la adición de adrenalina. MÉTODO: Este estudio prospectivo se llevó a cabo en 33 pacientes hipertensos consecutivos que acudieron a la clínica de exodoncia del Departamento de Cirugía Oral y Maxilofacial del Hospital Docente Universitario (LUTH), Idi-Araba, Lagos, desde diciembre 2004 a agosto 2005, para extracciones intra-alveolares. Los pacientes fueron colocados de forma aleatoria en dos grupos, según el tipo de solución anestésica empleada. Al grupo A se le realizó la extracción con lidocaína al 2% con 1:80 000 adrenalina, mientras que al grupo B se le realizó la extracción con lidocaína al 2% sin vasoconstrictor (lidocaína pura). A cada paciente se le extrajo una pieza. Mediciones de la presión arterial y el pulso fueron realizadas en el salón de espera antes dela cirugía, en la cirugía tras la inyección con la anestesia local, durante la extracción del diente, y 15 minutos después de la extracción. RESULTADOS: La muestra consistió en 20 hembras y 13 varones cuyo rango de edad fluctuó de 24 a 75 años (± SD media = 50.1 ± 11.7 años). No hubo diferencia estadísticamente significativa alguna entre la tensión arterial sistólica y la diastólica, ni con respecto a la tasa del pulso en los dos grupos luego de la administración de la anestesia local. Sin embargo, la alteración más alta de los parámetros se observó durante la extracción en los dos grupos. CONCLUSIÓN: Los cambios hemodinámicos inducidos por la inyección de lidocaína al 2% con adrenalina en los pacientes con hipertensión controlada durante la extracción, están dentro del rango normal y no son distintos de los inducidos mediante lidocaína al 2% sin adrenalina. Se considera fundamental que los profesionales de la salud tomen todas las precauciones para prevenir inyecciones intravasculares inadvertidas.