Frugal Casey's 1/2 price HTN deck

Question 1

What are some treatments for hypertension?

Answer 1

• Drugs- possibly combination of two for Stage 2 HTN
  
  • Diuretics
  • Ca channel blockers
  • ACE inhibitors
  • Beta blockers
  • Angiotensin receptor blockers
• Non-Drug
  
  • lifestyle changes- wt loss, smoking cessation, physical activity
  • Na restriction, diets
  • decrease ETOH
  • relaxation techniques

Question 2

Which BP meds would you used for different diseases? (chart)

Previous MI

Heart failure

CAD

DM

CKD

Recurrent stroke prevention

Answer 2

Question 4

What is the definition of a hypertensive crisis?

How is it treated?

Answer 4

• Sudden increase in diastolic BP above 130 mmHG due to activation of RAAS
• Treatment:
  
  • Prompt but controlled reduction with NTP
    
    • 0.5-10 mcg/kg/min IV
  • Monitor UOP and arterial BP
  • Decrease DBP to 100-110 over 30 min-1 hour

Question 5

What other meds (and doses) can you give to treat a hypertensive crisis?

Answer 5

• Nitroprusside 0.5-10 mcg/kg/min
  
  • drug of choice; short DOA
• Nitroglycerin 5-200 mcg/min
• Labetalol 40-80 mg q 10 min
• Esmolol 50-300 mcg/kg/min

Question 6

What do you need to consider regarding the anesthesia management of essential HTN?

Answer 6

• Is it controlled or uncontrolled?
• Is the surgery emergent or elective?
• Is there evidence of end organ damage?
  
  • angina
  • CHF
  • CVA
  • Renal insufficiency
  • PVD
• What is their medication regimen?

Question 7

If your patient has poorly controlled HTN, what should you expect during induction, maintenance, and Post-op managment?

Answer 7

• Induction
  
  • Exaggerated systemic blood pressure changes
  • try to limit time of DVL and SNS response
• Maintenance:
  
  • monitor for myocardial ischemia
  • monitor end-organ function (art line, foley)
  • adjust dept of anesthesia to minimize wide shifts in hemodynamics
• Post op
  
  • goal to minimize SNS response to surgical pain and N/V

Question 8

How can you minimize SNS stimulation with DVL?

Answer 8

• Any induction agent is appropriate except Ketamine
• Lidocaine 1-1.5 mg/kg
• Topical Lidocaine 2-4% (5 ml)
• Opioids
• Volatile agents

Question 9

How can you be prepared to adjust dept of anesthesia during maintenance to accomodate wide hemodynamic shifts?

Answer 9

• Choose an IA that is easily adjusted- Sevo or Des
  
  • d/t low B/G coefficient
  • Des can cause increased HR d/t SNS outflow when put on fast
• use a balanced technique
• have ephedrine, Phenylephrine readily available
• consder phenylephrine gtt if unable to get adequate dept of anesthesia
• **Cardiac IA of choice is usually Isoflurane

Question 10

How do you treat intraoperative hypertension?

Answer 10

• It is usually caused by pain!
  
  • incidence is higher in pts with essential HTN
• treatment
  
  • narcotics- esp if pain is obvious
  • IA’s
  • BB
  • NTG
  • nipride

Question 11

How do you treat intraoperative hypotension?

Answer 11

• Treatment
  
  • decrease anesthetic depth
  • Fluids or blood
  • Sympathomimetics
  • Check rhythm–> is it junctional?
    
    • maintain normocapnia
    • avoid high concentrations of IA’s
• **hypotension is worse for pts who are normally hypertensive b/c they are not used to having low BPS

Question 12

How would you want to monitor pts with HTN?

Answer 12

• 5 leak EKG
• A-line, CVP, PA cath if the surgery is extensive and ventricular dysfunction
• TEE

Question 13

How should you emerge a pt with HTN?

Answer 13

• Controlled emergence
• minimize sympathetic outflow
  
  • use narcotics
  • lidocaine
  • labetalol, esmolol, NTG
  • Deep extubation

Question 14

How can you control post-op hypertension?

Answer 14

• First ensure pain is adequately controlled
• If yes, then treat HTN with:
  
  • Hydralazine 2.5-10 mg IV q 20-30 min
  • Labetalol 5-20 mg IV q10 min
  • Nipride 0.5-10 mcg/kg/min