What is the most common circulatory disorder?
What percent of hypertensive patients becomes
hypertensive upon intubation? What is the goal when anesthetizing the medically controlled hypertensive patient?
20-25% of hypertensive patients become hypertensive upon intubation. The goal for managing induction of the hypertensive patient is to maintain blood pressure within 20-30% of the patient's usual level.
What class of drugs may be given preoperatively to the untreate,. asymptomatic, mildly hypertensive patient to attenuate tachycardia with tracheal intubation and tachycardia on emergence?
A small oral dose of a beta-adrenergic antagonist, such as labetalol (Normodyne, Trandate), atenolol (Tenormin), or oxprenolol (Trasicor) given preoperatively to the asymptomatic, mildly hypertensive patient may effectively attenuate tachycardia with tracheal intubation or upon emergence.
What is the goal during maintenance of anesthesia for the patient who has chronic hypertension? What anesthetic technique may be useful for achieving this goal?
The goal during maintenance of anesthesia is to avoid wide Ouctuations in blood pressure. A useful technique includes a volatile agent so rapid adjustments in anesthetic depth can be made in response to changes in blood pressure.
The blood pressure of the chronically hypertensive
patient increases substantially during the case. What is the most likely cause? What should you do?
Severe hypertension that occurs during a surgical procedure is most frequently due to inadequate anesthesia. Treat the hypertension by deepening the inspired concentration of inhaled agent if it is in use. If deepening the anesthesia is ineffective. add a continuous infusion of phentolamine (10 mg/250 mL) in normal saline or nitroprusside (1-2 mcg/kg/min).
What is another name for Takayasu's arteritis? What is the underlying disease process in Takayasu's arteritis? What segment of the population is primarily affected by this disease?
Takayasu's arteritis is also called pulseless disease because of the absence of palpable peripheral pulses. Chronic inflammation of the aorta and its major branches is the cause of the lack of peripheral pulses. Takayasu's arteritis primarily affects young Asian females.
What do most of the signs and symptoms of Takayasu's arteritis reflect?
Most of the signs and symptoms ofTakayasu's arteritis reflect decreased perfusion of organs secondary to occlusive inflammatory and thrombotic processes.
What are five central nervous system signs and symptoms ofTakayasu's arteritis?
Central nervous system signs and symptoms owing to involvement of the carotid arteries include: (1) vertigo, (2) visual disturbances, (3) syncope, (4) seizures, and (5) cerebral ischemia or infarction.
What five cardiovascular system signs and symptoms are seen in the patient with Takayasu's
Cardiovascular system signs and symptoms of Takayasu's arteritis include: (1) multiple occlusions of peripheral vessels, (2) ischemic heart disease. (3) cardiac valve dysfunction. (4)cardiac conduction defects. and
(5) renal artery stenosis.
The impact of Takayasu's arteritis on the pulmonary system results in what two signs and symptoms?
Patients with Takayasu's arteritis may exhibit (1) pulmonary hypertension and (2) ventilation-to-perfusion mismatch
What problems of the musculoskeletal system may be found in the patient with Takayasu's arteritis?
Ankylosing spondylitis and rheumatoid arthritis may accompany Takayasu's arteritis.
What is the primary treatment for Takayasu's arteritis?
Takayasu's arteritis is treated with corticosteroids.
There are six concerns for the management of anesthesia in the patient with Takayasu's arteritis. Identify three of them. (You will be asked to identify the other three concerns in the next question).
(1) Supplemental exogenous corticosteroids may be needed during the perioperative period because chronic corticosteroid therapy can suppress adrenocortical function; (2) regional anesthesia may be controversial if the patient is anticoagulated; (3) musculoskeletal changes (ankylosing spondylitis and rheumatoid arthritis) can make it difficult to perform lumbar epidural or spinal anesthesia.
List three other concerns for managing the
patient with Takayasu's arteritis.
(1) Blood pressure may be difficult to measure noninvasively in the upper extremities; (2) if carotid blood flow is compromised, electroencephalogram monitoring may be useful in detecting cerebral ischemia; (3) hyperextension of the neck during laryngoscopy for tracheal intubation may compromise blood flow through the carotid arteries, which may have shortened because of the vascular inflammatory process
What is the goal during anesthesia of the patient with Takayasu's arteritis? What should be avoided in this patient?
Maintaining an adequate perfusion pressure is the goal in the intraoperative period for the patient with Takayasu's arteritis. Hence, drug induced decreases in blood pressure should be avoided.
What two actions can you take to maintain cerebral perfusion during anesthesia for the patient with Takayasu's arteritis?
Avoid excessive hyperventilation. which would promote cerebral vasoconstriction secondary to a decrease in PaCO2, and use a volatile agent (volatile agents increase cerebral blood flow).