Managment in OMFS

1. DEPARTMENT OF ORAL AND
MAXILLOFACIAL SURGERY
TOPIC – MANAGMENT OF HYPERTENSIVE
PATIENTS
Submitted By,
Dr.Adharsh KM
KVG DENTAL COLLEGE,D.K

2. CONTENTS
DEFINITION
TYPES OF HYPERTENSION
CAUSES OF HYPERTENSION
TREATMENT MODIFICATIONS
DENTAL MANAGMENT BASED ON
BLOOD PRESSURE
ASA GRADING AND MANAGMENT
CLASSIFICATION
REGULATION OF BLOOD PRESSURE
CLINICAL FEATURES
REFERENCES

3. Hypertension is a condition in which
arterial blood pressure is chronically
elevated.
Hypertension refers to blood pressure that is
consistently above 140/90 mmHg (for more than 6
months). Hypertension may have no cause or may
be associated with any primary disease
HYPERTENSION

4. TYPES OF HYPERTENSION
ESSENTIAL/PRIMARY HYPERTENSION SECONDARY HYPERTENSION
HYPERTENSION
Condition of elevated blood pressure with
no underlying cause
Condition of elevated blood pressure with
some specific underlying cause

5. NORMAL BLOOD PRESSURE 120/80 mmHg
PRE-HYPERTENSION(At risk of
developing hypertension) <140/90mmHg
HYPERTENSION STAGE I <160/100mmHg
HYPERTENSION STAGE II <180/110mmHg
UNCONTROLLED HYPERTENSION =180/110mmHg or higher
CLASSIFICATION

6. ENVIRONMENTAL
FACTORS
I. STRESS
II. IMPAIRED INTRAUTERINE GROWTH
III. LACK OF EXERCISE
IV. CONSUMPTION OF ALCOHOL
V. HIGH SALT INTAKE
VI. OBESITY

7. CAUSES OF SECONDARY HYPERTENSION
RENAL DISEASE ENDOCRINE DISEASE COARCTATION OF
AORTA
CEREBRAL DISEASE
•RENAL ARTERY DISEASE
•PYELONEPHRITIS
•GLOMERULONEPHRITIS
•POLYCYSTIC DISEASE
•POSTTRANSPLANT
•CUSHING’S SYNDROME
•CORTICOSTEROID THERAPY
•HYPERALDOSTERONISM
•PHEOCHROMOCYTOMA
•ACROMEGALY
•HYPERTENSION IN
UPPER HALF OF BODY
ONLY
•ATHERO SCLEROSIS
•CEREBRAL
OEDEMA(mainly
strokes,head injuries
or tumors)

8. DRUG INDUCED HYPERTENSION
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
A 1 A 2 A 3 A 4
Article from US Pharm.
2008:33(9):HS11-HS20
By Darell Hullez,Rph,PharmD
Melissa Lagzdins,Rph,PharmD
NSAIDS & COX-2 INHIBITORS
IBUPROFEN,DICLOFENAC,CELECOXIB
CORTICOSTEROIDS
PREDNISONE,FLUDROCORTISONE,HYDR
OCORTISONE
IMMUNOSUPPRESSANTS
CYCLOSPORINE,TACROLIMUS
ESTROGENS & PROGESTINS
ORAL CONTRACEPTIVES,ERT/HRT

9. WHITE COAT HYPERTENSION
Transient increase in blood pressure in normal
individual when blood pressure is recorded in a
physician consultation room or in hospital

10. REGULATION OF BLOOD PRESSURE
By regulation of ECF volume &
Renin-Angiotensin mechanism
RENAL
By vasomotor center & impulse
from periphery
NERVOUS
By hormones causing
vasoconstriction & vasodilatation
HORMONAL
By local vasoconstrictor &
vasodilators
LOCAL

11. CLINICAL FEATURES
 SEVERE HEADACHE
 BLURRED VISION
 DIZZINESS
 NAUSEA
 VOMITING
 FATIGUE
 CONFUSION EPISTAXIS
 CHEST PAIN
 SHORTNESS OF BREATH
 IRREGULAR HEART BEAT
 PAPILLEDEMA

13. STRESS REDUCTION PROTOCOL
Premedicate the
patient with hypnotics
for a relaxed sleep the
night before the
surgery
Premedicate the
patient with sedatives
on the day of surgery
Schedule the surgery
in the morning
Minimise the patient
waiting time
Avoid any anxiety
during surgery
Reduce the length of
the appointment
Administer adequate
pain control measures
during surgery
Consider
psychosedation
during surgery

15. TREATMENT MODIFICATIONS
DENTAL ASPECTS
The blood pressure should be controlled before elective dental
treatment or the opinion of a physician should be sought first
Short minimally stressful appointments
Avoid anxiety and pain, since endogenous epinephrine released
in response to pain or fear may induce dysrhytmias.
Patients are best treated in the late morning. Endogenous
epinephrine levels peak during morning hours and adverse
cardiac events are most likely in the early morning.
Continuous BP monitoring is indicated
Raising patient suddenly from supine position may cause
postural hypotension If the patient is using antihypertensive drugs
such as THIAZIDES,FUROSEMIDE or CALCIUM CHANNEL
BLOCKER.

16. LOCAL ANAESTHESIA
Adequate analgesia and anaesthesia must be provided.
An aspirating syringe should be used to give a LA,since epinephrine given
intravenously may increase hypertension and precipitate dysrhytmias.
Epinephrine in combination with local anaesthetics is contraindicated in an
hypertensive patient with systolic pressure of more than 200 mmHg and/or diastolic
pressure of more than 115 mmHg
Epinephrine containing local anaesthetics should not be given in large doses to
patients taking nonselective beta-blockers,since interactions between epinephrine and
the beta-blocking agent may induce hypertension and cardiovascular complications
Conscious sedation may be advisable to control anxiety

17. IIIIIIIIIIIIIIID
0IIIIIIIIIIIIIII GENERAL ANAESTHESIA
•All antihypertensive drugs are potentiated by general anaesthetic agents and
can induce hypotension. Especially the case with barbiturates and opioids
•Intravenous barbiturates in particular can be dangerous in patients on
antihypertensive therapy, but halothane, enflurane and isoflurane may also
cause hypotension in patients on beta-blockers.
•Antihypertensive drugs should not be stopped, since rebound hypertension
can result.
•Hypertension may be a contraindication to general anaesthesia if complicated
by:
▪ Cardiac failure
▪ Coronary or cerebral artery insufficiency
▪ Renal insufficiency
•Chronic administration of some diuretics such as furosemide may lead to
potassium deficiency, which should, therefore, be checked preoperatively as it
may result in intraoperative complications such as dysrhythmia, increased
sensitivity to muscle relaxants such as curare.

18. REFERENCES
TEXTBOOK OF
ORAL&MAXILLOFACIAL
SURGERY BY NEELIMA
ANIL MALIK
TEXTBOOK OF ORAL
&MAXILLOFACIAL
SURGERY(3RD EDITION)
BY SM BALAJI
TEXTBOOK OF
ORAL&MAXILLOFACIAL
SURGERY BY RAJIV M
BORLE

19. THANK YOU