Clinical Considerations of Anesthetic Management for the Patient with Hypertension / 대한마취과학회지

ABSTRACT

It has been reported that the number of patients with hypertension increases yearly in the Korean population(Sohn et al, 1968; Lee, 1962; Kang et al, 1989), and this imposes many anesthetic problems during surgery. The etiology of essential hypertension is unknown, but it affects primarily the brain, heart and kindney. The main causes of mortality due to hypertension are cerebrovascular accident. congestive heart failure, myocardial infarction and uremia. For the better anesthetic management of patients with hypertension, it is essential to understand clearly the adrenergic machanism and pharmacologic action of antihypertensive drugs, especially their effects on hemodyamic circulation. About 15 years ago it was generally agreed that antihypertensive medication should be stopped some time before anesthesia and surgery in order to regain the compensatory function of the circulation during anesthesia and surgical stress (Armstrong Davison, 1951; Vadnam et al, 1961. Dingle, 1966). However the present concept is that the better the hypertension is controlled the better the patient's chances of surviving anesthesia and it is recommended that antihypertensive medication should be continued as close as possible to the time of anesthesia(Brown, 1978). The present study was undertaken to learn the effect of antihypertensive medication, given preoperatively, on the arterial blood pressure during general anesthesia, by reviewing the anesthesia courses of hypertensive patients who were admitted to Severance FIospital from March 1969 to February l978. The patients with hypertension were divided into two groups, one group consisting of 100 patients, who received antihypertensive medication in the preoperative period and the other group, consisting of 100 patients, who had not received antihypertensive medication for the control of high blood pressure preoperatively. Changes of arterial blood pressure during anesthesia were analyzed, and data were compared between two groups. The results are as follows; 1) The number of the patients with hypertension, admitted to the hospital, has been increasing yearly for the past 10 year period(March, 1969 to February 1978). 2) The patients who received antihypertensive medication for preoperative anesthetic management showed less arterial blood pressure fluctuation during general anesthesia, compared to the patients who had not received antihypertensive medication (p<0.05). It may be suggested from the above observation that the preoperative control of hypertension is desirable for the maintenance of a stable blood pressure during general anesthesia.