Post-operative high blood pressure

Postoperative hypertension (HT) is defined as a significant rise in blood pressure (BP) during the immediate postoperative period that can lead to serious neurological, cardiovascular or surgical complications requiring urgent management. In non-cardiac surgery, HT is common and leads to an increase in adverse events, including stroke, injury and myocardial infarction, and bleeding. In certain procedures, such as carotid endarterectomy, aortic aneurysm surgery or intracranial surgery, postoperative HT has specific considerations not present in other surgeries and may be associated with worse neurological outcomes. Among the risk factors for its occurrence is the history of hypertension prior to surgery, although not all episodes of postoperative hypertension correspond to chronic hypertensive patients. In the first hours after surgery, pain, agitation, hypoxemia or bladder distension, among other factors, may contribute to the appearance of hypertension. Although there is no clear consensus on the thresholds and goals of antihypertensive therapy, it is usually initiated when the systolic BP is > 180 mmHg or the diastolic BP is > 110 mmHg, especially if it persists after treating possible underlying causes. The use of oral medication in the postoperative period may be limited by the circumstances of the surgery, but also by the slow onset of action of the drugs and the difficulty of controlling the degree of pressure drop. If oral administration of medication is not feasible, we recommend the use of short-acting intravenous drugs. The choice of antihypertensive drug will depend on the clinical situation and conditions of the patient, and should take into account the pharrnacokinetic and pharmacodynamic parameters of the different agents available. (C) 2019 Sociedad Espanola de Anestesiologia, Reanimacion y Terapeutica del Dolor. Published by Elsevier Espana, S.L.U. All rights reserved.