Intraoperative Hypertension - Guidelines for Crises in Anaesthesia Hypertension is most commonly due to inappropriate depth of anaesthesia or inadequate analgesia. You should rapidly exclude a problem in adequate oxygen delivery, airway and breathing first. ❶ Immediate actions • Recheck blood pressure AND increase anaesthesia AND reduce stimulus. ❷ Adequate oxygen delivery • Check fresh gas flow for circuit in use AND check measured FiO2. • Visual inspection of entire breathing system including valves and connections. • Rapidly confirm reservoir bag moving OR ventilator bellows moving. ❸ Airway • Check position of airway device and listen for noise (including larynx and stomach). • Check capnogram shape compatible with patent airway. • Confirm airway device is patent (consider passing suction catheter). ❹ Breathing - exclude hypoxia and hypercarbia as causes: • Check chest symmetry, rate, breath sounds, SpO2, measured VTexp, ETCO2. • Feel the airway pressure using reservoir bag and APL valve <3 breaths. ❺ Circulation • Check rate, rhythm, perfusion; increase frequency of BP check. • Check cuff size and location, consider intra-arterial monitoring. ❻ Depth • Ensure adequate depth of anaesthesia and analgesia. ❼ Consider underlying problem (Box B). ❽ Call for help and consider temporising drug (Box C) if problem not resolving. POTENTIAL UNDERLYING PROBLEMS • Inadequate anaesthesia / analgesia (alfentanil can be diagnostic – see Box C for dose) • Inadequate neuromuscular blockade • Consider whether you could have made a drug error • Omission of usual antihypertensives • Distended bladder • Vasopressor administered by surgeon • Surgical tourniquet • Excess fluid (over-administration / overload / TURP syndrome) • Medical causes: drug interaction, renal failure, raised intracranial pressure, seizure, thyrotoxicosis, phaeochromocytoma By Association of Anaesthetists @ https://twitter.com/AAGBI Quick Reference Handbook - Guidelines for crises in anaesthesia #Hypertension #Anesthesiology #Anesthesia #Intraoperative #Checklist #Diagnosis #Management #Workup
