1. Chronic renal failure occurs when glomerular filtration rate is reduced to less than 10% of normal function for over 3 months. It is caused by conditions like diabetes, hypertension, glomerulonephritis.
2. It leads to fluid, electrolyte and acid-base imbalances, anemia, bone disease, neuropathy, impaired drug handling and increased risk of infections.
3. Anesthesia management includes preoperative correction of abnormalities, modified drug dosing and strict asepsis to prevent infections in the immunocompromised patient.
Mr. Rahul, a 52-year-old male with a history of hypertension, bilateral renal artery stenosis, and dyslipidemia, presented to the emergency room with worsening headache, confusion, numbness on his right side, and blurry vision over the past 12 hours. On examination, his blood pressure was extremely elevated at 230/130 mmHg and he showed signs of mild weakness on his right side.
The working diagnosis for Mr. Rahul is secondary hypertension presenting as a hypertensive emergency. His case requires urgent treatment to lower his blood pressure to prevent end organ damage, with a goal of reducing his blood pressure by 15-20% within the first hour and gradually reaching normal levels within 24
This document discusses hypertensive crises and hypertension. It defines normal blood pressure and stages of high blood pressure. Hypertensive crisis is a medical emergency occurring when blood pressure is above 180/110. The document outlines causes like lifestyle factors, risk factors like age and race, types of hypertension like malignant or renal, symptoms, complications affecting organs, diagnosis via blood pressure reading, emergency management using drugs to lower blood pressure, and long-term management.
This document discusses hypertension (high blood pressure). It defines hypertension and lists its learning objectives. It describes the epidemiology, classification, etiology, pathophysiology, clinical manifestations, diagnostic approach, and management of hypertension. Hypertension is a major modifiable risk factor for heart disease and stroke. Accurate measurement over multiple visits is important for diagnosis. Evaluation of patients with hypertension includes establishing baseline blood pressure, identifying secondary causes, checking for target organ damage, and determining other risk factors. Symptoms are usually absent, but may include headache or signs of end organ damage.
This document defines hypertensive crises and differentiates between hypertensive urgency and emergency. It describes the signs, symptoms, and treatment for each. For the clinical vignette, the diagnosis is hypertensive emergency based on retinal findings of end-organ damage. The next step in management is intravenous antihypertensive medication to reduce blood pressure by 25% over 2-6 hours in the intensive care unit, followed by oral antihypertensives and close follow-up.
This document discusses hypertension (high blood pressure), including its causes, symptoms, diagnosis, and treatment. It defines hypertension and describes its classification. It also outlines lifestyle modifications and medications that are used to treat hypertension. The goals of treatment are to lower blood pressure and prevent target organ damage to the heart, brain, kidneys and eyes. Nursing care focuses on educating patients, monitoring for side effects, ensuring compliance with treatment, and evaluating treatment effectiveness.
Management of hypertensive condition in 2020 according to AHA/ASA guidelines. We will discuss the presentation, clinical assessment, investigations, and management of hypertension along with major randomized controlled trials and guidelines.
Hypertension, or high blood pressure, affects nearly 1 billion people worldwide. It is a leading cause of death and is poorly controlled in many countries. May 14th is recognized as World Hypertension Day to increase awareness. Hypertension is defined as a systolic blood pressure over 140 mmHg or a diastolic over 90 mmHg. Lifestyle modifications like weight loss, dietary changes, and increased physical activity can help control blood pressure but medication is often required. Treatment goals are to reduce blood pressure below 140/90 mmHg or 130/80 for those with diabetes or kidney disease to lower the risks of complications.
Mr. Rahul, a 52-year-old male with a history of hypertension, bilateral renal artery stenosis, and dyslipidemia, presented to the emergency room with worsening headache, confusion, numbness on his right side, and blurry vision over the past 12 hours. On examination, his blood pressure was extremely elevated at 230/130 mmHg and he showed signs of mild weakness on his right side.
The working diagnosis for Mr. Rahul is secondary hypertension presenting as a hypertensive emergency. His case requires urgent treatment to lower his blood pressure to prevent end organ damage, with a goal of reducing his blood pressure by 15-20% within the first hour and gradually reaching normal levels within 24
This document discusses hypertensive crises and hypertension. It defines normal blood pressure and stages of high blood pressure. Hypertensive crisis is a medical emergency occurring when blood pressure is above 180/110. The document outlines causes like lifestyle factors, risk factors like age and race, types of hypertension like malignant or renal, symptoms, complications affecting organs, diagnosis via blood pressure reading, emergency management using drugs to lower blood pressure, and long-term management.
This document discusses hypertension (high blood pressure). It defines hypertension and lists its learning objectives. It describes the epidemiology, classification, etiology, pathophysiology, clinical manifestations, diagnostic approach, and management of hypertension. Hypertension is a major modifiable risk factor for heart disease and stroke. Accurate measurement over multiple visits is important for diagnosis. Evaluation of patients with hypertension includes establishing baseline blood pressure, identifying secondary causes, checking for target organ damage, and determining other risk factors. Symptoms are usually absent, but may include headache or signs of end organ damage.
This document defines hypertensive crises and differentiates between hypertensive urgency and emergency. It describes the signs, symptoms, and treatment for each. For the clinical vignette, the diagnosis is hypertensive emergency based on retinal findings of end-organ damage. The next step in management is intravenous antihypertensive medication to reduce blood pressure by 25% over 2-6 hours in the intensive care unit, followed by oral antihypertensives and close follow-up.
This document discusses hypertension (high blood pressure), including its causes, symptoms, diagnosis, and treatment. It defines hypertension and describes its classification. It also outlines lifestyle modifications and medications that are used to treat hypertension. The goals of treatment are to lower blood pressure and prevent target organ damage to the heart, brain, kidneys and eyes. Nursing care focuses on educating patients, monitoring for side effects, ensuring compliance with treatment, and evaluating treatment effectiveness.
Management of hypertensive condition in 2020 according to AHA/ASA guidelines. We will discuss the presentation, clinical assessment, investigations, and management of hypertension along with major randomized controlled trials and guidelines.
Hypertension, or high blood pressure, affects nearly 1 billion people worldwide. It is a leading cause of death and is poorly controlled in many countries. May 14th is recognized as World Hypertension Day to increase awareness. Hypertension is defined as a systolic blood pressure over 140 mmHg or a diastolic over 90 mmHg. Lifestyle modifications like weight loss, dietary changes, and increased physical activity can help control blood pressure but medication is often required. Treatment goals are to reduce blood pressure below 140/90 mmHg or 130/80 for those with diabetes or kidney disease to lower the risks of complications.
Hypertension has many potential causes and treatments depending on the clinical situation. Secondary hypertension should be considered when initial control is difficult or the onset of hypertension is rapid. Treatment of hypertensive emergencies involves gradual reduction of blood pressure while avoiding hypotension, using agents like sodium nitroprusside or labetalol. Long-term regimens after crisis typically include vasodilators, beta-blockers, and diuretics. Management is tailored based on any underlying conditions and target organ effects.
This document provides information on hypertensive emergencies and urgencies, including their classification, evaluation, and management. It defines hypertensive emergencies as severe hypertension with evidence of acute target organ damage, while urgencies involve severe hypertension without organ damage. For emergencies, rapid parenteral treatment is needed to stop organ damage progression while avoiding hypoperfusion. Several parenteral agents are discussed for specific conditions along with their dosing and side effects. The goal is to lower blood pressure gradually to avoid complications. Hypertensive urgencies can often be treated orally as outpatients after initial control.
Diagnosis and management of hypertension and hypertensive emergencySheela Aglecha
The document provides guidelines for the diagnosis and management of hypertension in children and adolescents. It defines normal blood pressure levels based on age and sex. It recommends using ambulatory blood pressure monitoring for accurate diagnosis and discusses frequent monitoring and lifestyle/pharmacological interventions. For acute severe hypertension, it advises reducing blood pressure gradually over 24 hours to avoid complications, with the goal below the 95th percentile.
Antihypertensives are a class of drugs that are used to treat hypertension (high blood pressure). Antihypertensive therapy seeks to prevent the complications of high blood pressure, such as stroke and myocardial infarction.
Hypertensive crisis is defined as a severe increase in blood pressure that requires prompt treatment to prevent end organ damage. There are two categories: hypertensive urgency, where blood pressure is elevated but there is no acute organ damage; and hypertensive emergency, where elevated blood pressure is associated with acute organ damage. Patients with hypertensive urgency can be treated orally to lower blood pressure by 25% over 24 hours, while those with emergency require rapid intravenous treatment to lower it by 10-25% within minutes to hours. Rapid reduction of blood pressure should be avoided to prevent ischemic events.
This document discusses hypertensive emergencies, which are severe cases of high blood pressure that result in acute organ damage. It defines categories of hypertensive states and provides details on etiology, pathophysiology, presentation, workup, and treatment of hypertensive emergencies. Treatment involves identifying the affected organ system and gradually lowering blood pressure over hours to days to prevent further organ injury, using intravenous medications like nitroprusside, labetalol, or nicardipine depending on the situation. Specific guidance is provided for rapidly lowering blood pressure in conditions like hypertensive encephalopathy, intracerebral hemorrhage, and ischemic stroke.
This document provides information on the diagnosis and management of hypertension. It defines hypertension as blood pressure greater than 140/90 mmHg. It describes the types and causes of hypertension, including essential (95% of cases, no identifiable cause) and secondary (underlying cause such as renal or endocrine issues). Target organ damage from uncontrolled hypertension includes effects on the heart, brain, kidneys, and retina. Lifestyle modifications and medication are used to treat hypertension with the goals of reducing blood pressure below 140/90 mmHg to prevent cardiovascular events. Common classes of antihypertensive medications discussed include diuretics, beta-blockers, ACE inhibitors, calcium channel blockers, and angiotensin receptor blockers.
This document discusses the management of hypertensive emergencies in children. It defines hypertension and hypertensive crises, and outlines the urgency vs emergency distinction. It describes the prevalence of hypertension in children, potential causes, pathophysiology, and complications involving end organ damage if left untreated. Initial diagnostic approach involves assessing for end organ injury and its severity, with the immediate goal of therapy being to decrease blood pressure quickly in emergency situations.
1. The document discusses hypertensive emergencies and urgencies, their causes, manifestations, evaluation, and management.
2. Initial evaluation involves assessing for target organ damage by examining cardiovascular, neurological, and renal systems. Laboratory tests and imaging help identify secondary causes and end-organ effects.
3. Intravenous antihypertensives like sodium nitroprusside, nicardipine, and labetalol are used to lower blood pressure in hypertensive emergencies to prevent further organ damage, while oral medications are preferred for urgencies.
This document discusses hypertensive urgency and emergency. Hypertensive urgency is severely elevated blood pressure without target organ damage, with symptoms like headache and dizziness. Treatment involves slowly lowering blood pressure over hours to days. Hypertensive emergency is elevated blood pressure that results in organ damage to the brain, heart, or kidneys, requiring immediate treatment to lower blood pressure within minutes to hours to prevent further damage. Specific treatments depend on the affected organ and may include drugs like labetalol, nicardipine, and sodium nitroprusside. The main difference between urgency and emergency is that emergency involves organ damage while urgency does not.
Hypertension (HTN) is a major health problem known as the "silent killer" due to its asymptomatic nature. It is classified by the ACC/AHA and other guidelines into normal, elevated, stage 1, and stage 2 categories based on systolic and diastolic blood pressure readings. HTN can be primary (essential) or secondary to other medical conditions and is a leading cause of heart disease and stroke. Treatment involves lifestyle modifications like diet, exercise, and weight loss as well as antihypertensive medications like thiazide diuretics, ACE inhibitors, ARBs, and calcium channel blockers, often in combination therapy. Medication and treatment goals depend on the severity and type of HTN as
This document summarizes drugs used to manage hypotension and hypertension. It discusses drugs that can be used to treat hypotension like norepinephrine, phenylephrine, and methoxamine, which are direct-acting alpha agonists that increase blood pressure by constricting blood vessels. It also discusses various classes of drugs to treat hypertension, including ACE inhibitors, ARBs, calcium channel blockers, diuretics, and vasodilators. Each drug class is explained in terms of its mechanism of action and examples are provided of commonly used drugs within each class. Adverse effects are also outlined for each drug class.
The SPRINT trial examined the effects of more intensive vs standard blood pressure treatment in over 9,000 adults age 50 or older with high blood pressure. Participants were randomized to a systolic blood pressure goal of less than 120 mm Hg (intensive) or less than 140 mm Hg (standard). The trial found that the primary composite cardiovascular outcome occurred at a 25% lower rate in the intensive treatment group compared to standard treatment. All-cause mortality was also 27% lower with intensive treatment. Intensive treatment resulted in more frequent adverse events like hypotension but overall benefits were found to exceed potential harms.
This document discusses hypertensive crisis, which can manifest as either an emergency or urgency depending on the presence of acute or progressive end-organ damage. Hypertensive emergencies require immediate treatment to reduce blood pressure to prevent irreversible organ damage and death. Examples include accelerated or malignant hypertension and hypertensive encephalopathy. Hypertensive urgencies involve elevated blood pressure without symptoms or organ damage, allowing more gradual blood pressure reduction. Proper classification and treatment can improve outcomes for patients experiencing hypertensive crisis.
This is all about the Emergency management of HTN. No Matters at which setting You are,it will be beneficial for You to Practice Against High Blood Pressure.
Essential hypertension management and treatmentFabio Grubba
This document discusses hypertension (high blood pressure), including its classification, causes, symptoms, diagnosis, and treatment. It defines the different stages of hypertension according to blood pressure readings. Lifestyle modifications are recommended initially, including diet changes and exercise. If lifestyle changes do not control blood pressure, medications such as diuretics, beta-blockers, calcium channel blockers, ACE inhibitors, and other drug classes may be used. The goal of treatment is to prevent complications in target organs like the heart, brain, and kidneys by maintaining a blood pressure below 140/90 mmHg.
HYPERTENSION introduction, recommendations for accurate measurements of BP, evaluation of patient with hypertension, management of patient with hypertension, resistant hypertension, hypertensive crisis, hypertensive emergencies
This document provides an overview of hypertension for pharmacotherapy students. It defines hypertension and classifies blood pressure levels. It discusses the underlying causes, risk factors, symptoms, complications, goals of treatment, and appropriate evaluation. It also describes the major classes of antihypertensive drugs including ACE inhibitors, ARBs, calcium channel blockers, thiazide diuretics, and beta blockers. Treatment approaches are outlined based on clinical guidelines. The document is intended to help students understand the diagnosis and management of hypertension.
The document discusses guidelines for treating hypertension, including:
1) Lifestyle modifications and drug therapy are recommended to reduce hypertension-related organ damage and mortality. Primary drug classes include diuretics, ACE inhibitors, ARBs, beta-blockers, and calcium channel blockers.
2) Treatment approaches vary for specific conditions like heart failure, heart attack, diabetes, and kidney disease. For example, ACE inhibitors plus diuretics and beta-blockers are recommended for heart failure.
3) Drug selection depends on other factors like age, risk of side effects, and concomitant diseases or conditions. Combination drug therapy is often needed to control blood pressure.
This document discusses considerations for anesthesia after renal transplantation. It notes that most transplant recipients have stage 2-3 chronic kidney disease, with GFR declining over time. A thorough pre-operative evaluation assesses renal function, risk of rejection, comorbidities, medications, and infections. Intraoperatively, regional or general anesthesia can be used while avoiding nephrotoxic drugs and carefully monitoring renal function and fluid status. Post-operatively, renal function, electrolytes, infections, and analgesia must be monitored closely.
Hypertension has many potential causes and treatments depending on the clinical situation. Secondary hypertension should be considered when initial control is difficult or the onset of hypertension is rapid. Treatment of hypertensive emergencies involves gradual reduction of blood pressure while avoiding hypotension, using agents like sodium nitroprusside or labetalol. Long-term regimens after crisis typically include vasodilators, beta-blockers, and diuretics. Management is tailored based on any underlying conditions and target organ effects.
This document provides information on hypertensive emergencies and urgencies, including their classification, evaluation, and management. It defines hypertensive emergencies as severe hypertension with evidence of acute target organ damage, while urgencies involve severe hypertension without organ damage. For emergencies, rapid parenteral treatment is needed to stop organ damage progression while avoiding hypoperfusion. Several parenteral agents are discussed for specific conditions along with their dosing and side effects. The goal is to lower blood pressure gradually to avoid complications. Hypertensive urgencies can often be treated orally as outpatients after initial control.
Diagnosis and management of hypertension and hypertensive emergencySheela Aglecha
The document provides guidelines for the diagnosis and management of hypertension in children and adolescents. It defines normal blood pressure levels based on age and sex. It recommends using ambulatory blood pressure monitoring for accurate diagnosis and discusses frequent monitoring and lifestyle/pharmacological interventions. For acute severe hypertension, it advises reducing blood pressure gradually over 24 hours to avoid complications, with the goal below the 95th percentile.
Antihypertensives are a class of drugs that are used to treat hypertension (high blood pressure). Antihypertensive therapy seeks to prevent the complications of high blood pressure, such as stroke and myocardial infarction.
Hypertensive crisis is defined as a severe increase in blood pressure that requires prompt treatment to prevent end organ damage. There are two categories: hypertensive urgency, where blood pressure is elevated but there is no acute organ damage; and hypertensive emergency, where elevated blood pressure is associated with acute organ damage. Patients with hypertensive urgency can be treated orally to lower blood pressure by 25% over 24 hours, while those with emergency require rapid intravenous treatment to lower it by 10-25% within minutes to hours. Rapid reduction of blood pressure should be avoided to prevent ischemic events.
This document discusses hypertensive emergencies, which are severe cases of high blood pressure that result in acute organ damage. It defines categories of hypertensive states and provides details on etiology, pathophysiology, presentation, workup, and treatment of hypertensive emergencies. Treatment involves identifying the affected organ system and gradually lowering blood pressure over hours to days to prevent further organ injury, using intravenous medications like nitroprusside, labetalol, or nicardipine depending on the situation. Specific guidance is provided for rapidly lowering blood pressure in conditions like hypertensive encephalopathy, intracerebral hemorrhage, and ischemic stroke.
This document provides information on the diagnosis and management of hypertension. It defines hypertension as blood pressure greater than 140/90 mmHg. It describes the types and causes of hypertension, including essential (95% of cases, no identifiable cause) and secondary (underlying cause such as renal or endocrine issues). Target organ damage from uncontrolled hypertension includes effects on the heart, brain, kidneys, and retina. Lifestyle modifications and medication are used to treat hypertension with the goals of reducing blood pressure below 140/90 mmHg to prevent cardiovascular events. Common classes of antihypertensive medications discussed include diuretics, beta-blockers, ACE inhibitors, calcium channel blockers, and angiotensin receptor blockers.
This document discusses the management of hypertensive emergencies in children. It defines hypertension and hypertensive crises, and outlines the urgency vs emergency distinction. It describes the prevalence of hypertension in children, potential causes, pathophysiology, and complications involving end organ damage if left untreated. Initial diagnostic approach involves assessing for end organ injury and its severity, with the immediate goal of therapy being to decrease blood pressure quickly in emergency situations.
1. The document discusses hypertensive emergencies and urgencies, their causes, manifestations, evaluation, and management.
2. Initial evaluation involves assessing for target organ damage by examining cardiovascular, neurological, and renal systems. Laboratory tests and imaging help identify secondary causes and end-organ effects.
3. Intravenous antihypertensives like sodium nitroprusside, nicardipine, and labetalol are used to lower blood pressure in hypertensive emergencies to prevent further organ damage, while oral medications are preferred for urgencies.
This document discusses hypertensive urgency and emergency. Hypertensive urgency is severely elevated blood pressure without target organ damage, with symptoms like headache and dizziness. Treatment involves slowly lowering blood pressure over hours to days. Hypertensive emergency is elevated blood pressure that results in organ damage to the brain, heart, or kidneys, requiring immediate treatment to lower blood pressure within minutes to hours to prevent further damage. Specific treatments depend on the affected organ and may include drugs like labetalol, nicardipine, and sodium nitroprusside. The main difference between urgency and emergency is that emergency involves organ damage while urgency does not.
Hypertension (HTN) is a major health problem known as the "silent killer" due to its asymptomatic nature. It is classified by the ACC/AHA and other guidelines into normal, elevated, stage 1, and stage 2 categories based on systolic and diastolic blood pressure readings. HTN can be primary (essential) or secondary to other medical conditions and is a leading cause of heart disease and stroke. Treatment involves lifestyle modifications like diet, exercise, and weight loss as well as antihypertensive medications like thiazide diuretics, ACE inhibitors, ARBs, and calcium channel blockers, often in combination therapy. Medication and treatment goals depend on the severity and type of HTN as
This document summarizes drugs used to manage hypotension and hypertension. It discusses drugs that can be used to treat hypotension like norepinephrine, phenylephrine, and methoxamine, which are direct-acting alpha agonists that increase blood pressure by constricting blood vessels. It also discusses various classes of drugs to treat hypertension, including ACE inhibitors, ARBs, calcium channel blockers, diuretics, and vasodilators. Each drug class is explained in terms of its mechanism of action and examples are provided of commonly used drugs within each class. Adverse effects are also outlined for each drug class.
The SPRINT trial examined the effects of more intensive vs standard blood pressure treatment in over 9,000 adults age 50 or older with high blood pressure. Participants were randomized to a systolic blood pressure goal of less than 120 mm Hg (intensive) or less than 140 mm Hg (standard). The trial found that the primary composite cardiovascular outcome occurred at a 25% lower rate in the intensive treatment group compared to standard treatment. All-cause mortality was also 27% lower with intensive treatment. Intensive treatment resulted in more frequent adverse events like hypotension but overall benefits were found to exceed potential harms.
This document discusses hypertensive crisis, which can manifest as either an emergency or urgency depending on the presence of acute or progressive end-organ damage. Hypertensive emergencies require immediate treatment to reduce blood pressure to prevent irreversible organ damage and death. Examples include accelerated or malignant hypertension and hypertensive encephalopathy. Hypertensive urgencies involve elevated blood pressure without symptoms or organ damage, allowing more gradual blood pressure reduction. Proper classification and treatment can improve outcomes for patients experiencing hypertensive crisis.
This is all about the Emergency management of HTN. No Matters at which setting You are,it will be beneficial for You to Practice Against High Blood Pressure.
Essential hypertension management and treatmentFabio Grubba
This document discusses hypertension (high blood pressure), including its classification, causes, symptoms, diagnosis, and treatment. It defines the different stages of hypertension according to blood pressure readings. Lifestyle modifications are recommended initially, including diet changes and exercise. If lifestyle changes do not control blood pressure, medications such as diuretics, beta-blockers, calcium channel blockers, ACE inhibitors, and other drug classes may be used. The goal of treatment is to prevent complications in target organs like the heart, brain, and kidneys by maintaining a blood pressure below 140/90 mmHg.
HYPERTENSION introduction, recommendations for accurate measurements of BP, evaluation of patient with hypertension, management of patient with hypertension, resistant hypertension, hypertensive crisis, hypertensive emergencies
This document provides an overview of hypertension for pharmacotherapy students. It defines hypertension and classifies blood pressure levels. It discusses the underlying causes, risk factors, symptoms, complications, goals of treatment, and appropriate evaluation. It also describes the major classes of antihypertensive drugs including ACE inhibitors, ARBs, calcium channel blockers, thiazide diuretics, and beta blockers. Treatment approaches are outlined based on clinical guidelines. The document is intended to help students understand the diagnosis and management of hypertension.
The document discusses guidelines for treating hypertension, including:
1) Lifestyle modifications and drug therapy are recommended to reduce hypertension-related organ damage and mortality. Primary drug classes include diuretics, ACE inhibitors, ARBs, beta-blockers, and calcium channel blockers.
2) Treatment approaches vary for specific conditions like heart failure, heart attack, diabetes, and kidney disease. For example, ACE inhibitors plus diuretics and beta-blockers are recommended for heart failure.
3) Drug selection depends on other factors like age, risk of side effects, and concomitant diseases or conditions. Combination drug therapy is often needed to control blood pressure.
This document discusses considerations for anesthesia after renal transplantation. It notes that most transplant recipients have stage 2-3 chronic kidney disease, with GFR declining over time. A thorough pre-operative evaluation assesses renal function, risk of rejection, comorbidities, medications, and infections. Intraoperatively, regional or general anesthesia can be used while avoiding nephrotoxic drugs and carefully monitoring renal function and fluid status. Post-operatively, renal function, electrolytes, infections, and analgesia must be monitored closely.
Hypertension, also known as high blood pressure, is a medical condition defined as blood pressure above 140/90 mmHg. It is often asymptomatic but can lead to serious health issues like heart disease or stroke if left untreated. Treatment involves lifestyle modifications like reducing salt intake, exercise, and weight loss. Medications may also be prescribed depending on severity, such as ACE inhibitors, calcium channel blockers, beta blockers, or diuretics. For hypertensive emergencies with very high blood pressure, intravenous drugs are used to rapidly lower the pressure.
Nanotechnology involves manipulating materials at the nanoscale level of 1 to 100 nanometers. It can be used to modify construction materials like concrete, improving properties such as strength, water resistance, and self-cleaning abilities. Some common nano-materials discussed are nano-silica, nano-titanium oxide, nano-iron oxide, nano-alumina, nanosized cement particles, nanobinders, nanoclay particles, carbon nanotubes, and nanosensors. While nanotechnology offers improvements, its high costs and potential health effects are limitations that require further research.
The document discusses latex allergy, including how increased latex glove use has led to more cases of latex allergy. It describes the potential reactions from latex exposure, from mild skin irritation to life-threatening anaphylaxis. Diagnosis and management of latex allergy is outlined, including avoidance of latex sources and emergency treatment of anaphylactic reactions.
This document describes screening models used to evaluate antihypertensive agents, including both in vitro and in vivo models. It discusses several specific in vitro models like α2-adrenoreceptor binding assays and assays measuring inhibition of angiotensin converting enzyme. It also lists various in vivo models used in rats and dogs to study acute and chronic forms of hypertension. The goal is to screen potential antihypertensive drugs and understand their mechanisms of action through these screening models before testing in clinical trials.
Neuromuscular weakness related to critical illnessDr Kumar
Critical illness myopathy (CIM) is the most common cause of neuromuscular weakness in intensive care unit patients. It results from critical illness and treatments like glucocorticoids. CIM causes flaccid quadriparesis through selective loss of myosin. Diagnosis is based on onset after critical illness and features like electrical inexcitability on muscle stimulation. Treatment involves managing the underlying illness and discontinuing glucocorticoids. Recovery can take weeks to months. Critical illness polyneuropathy (CIP) also occurs through axonal injury, likely from ischemia. It causes limb weakness and sensory loss. Both CIM and CIP can occur together.
DNR in Emergency Department - The Practice and the Islamic view Rashid Abuelhassan
The document discusses end-of-life care and do-not-resuscitate (DNR) orders. It provides guidance on when DNR is appropriate according to different medical conditions and opinions of specialists. DNR policies are discussed for different countries and regions, noting they can vary significantly. The key messages are that palliative care does not automatically mean DNR; DNR only refers to chest compressions and not other interventions like airway maneuvers or fluids in some cases; and the validity and requirements of DNR orders should be confirmed according to the local hospital policies. Communication with families is also emphasized.
Anaesthetic management of conjoined twins’Dr Kumar
Dr. Kumar presented on the topic of conjoined twins. Some key points:
- Conjoined twins occur in approximately 1 in 50,000 births and are always the same sex. They result from a single fertilized egg that only partially splits.
- Classification is based on the point of conjunction. The most common types are thoracopagus (chest) and omphalopagus (abdomen).
- Separation surgery requires extensive planning due to risks of circulatory mixing between twins. Careful monitoring and individualized dosing of anesthesia drugs is needed.
- The challenges include potential airway issues, assessing cardiovascular and respiratory systems, and ensuring adequate monitoring and equipment for each twin. Metic
This document provides an overview of hypertension (HTN) presented by Dr. Alim Al Razy. It defines HTN and describes the different types. Primary or essential HTN has unknown causes but is associated with genetic and lifestyle factors. Secondary HTN has identifiable causes like alcohol, obesity, or kidney disease. Management of HTN involves lifestyle modifications and medication choices depending on comorbidities. Antihypertensive drug classes discussed include diuretics, beta blockers, ACE inhibitors, calcium channel blockers, and more. Complications of uncontrolled HTN are also reviewed.
Mechanisms of cerebral injury and cerebral protectionDr Kumar
This document discusses mechanisms of cerebral injury and cerebral protection. It provides details on cerebral physiology including metabolism, blood flow, regulation of blood flow, and factors that influence blood flow such as perfusion pressure, autoregulation, respiratory gas tensions, temperature, viscosity, and autonomic influences. It also discusses intracranial pressure, signs of increased ICP, assessment of injury severity, and strategies and principles for cerebral protection including maintaining oxygen supply and reducing increases in ICP, cerebral metabolic rate, and cell damage. The effects of various anesthetic drugs on cerebral blood flow, metabolism, and injury are also summarized.
A 44-year-old woman collapsed at work and received bystander CPR and defibrillation. She was intubated by EMS and taken to the ED with a pulse but exhibiting seizure activity and a minimally responsive neurological exam. The document then discusses therapeutic hypothermia for cardiac arrest survivors including how to induce and maintain cooling, potential complications, and prognostic factors.
A 61-year-old man presented with worsening right thoracic pain and dyspnea three days after being discharged from cardiology following pacemaker implantation for sick sinus syndrome. A 60-year-old woman with an implanted pacemaker presented with dizziness and fainting. A 77-year-old woman who had a pacemaker implanted for symptomatic sinus bradycardia presented one week later with continuous chest pain. An elderly patient presented 6 months after pacemaker implantation with a recurrence of exertional shortness of breath.
This document provides an overview of shock, including its history, definitions, types, pathophysiology, signs and symptoms, and management. It discusses the four main types of shock - cardiogenic, obstructive, hypovolemic, and distributive - describing the insult, physiologic effects, and compensatory mechanisms for each. Treatment of shock focuses on the ABCDE approach - airway, breathing, circulation, disability, and exposure. Restoring adequate circulation through fluid resuscitation is key. The goals of treatment are to optimize oxygen delivery and achieve endpoints of resuscitation like urine output and hemodynamic parameters.
This document discusses the history, techniques, and physiology of controlled hypotensive anesthesia. It began in 1917 to provide a bloodless surgical field for neurosurgery. Various techniques were developed over time using drugs like nitroprusside and anesthetics to safely lower blood pressure. Key aspects include carefully monitoring vital organ perfusion and using positioning, ventilation, and fluids to potentiate the effects while avoiding dangerous drops in blood flow to the brain, heart, kidneys and other organs.
SYSTEMIC HYPERTENSION AND SCOPE OF HOMOEOPATHY
Dr. Smita Brahmachari
Abstract:
Hypertension (HTN) is an enormous health problem and is one of the biggest health challenges in the 21st century. Although the condition is common, readily detectable, and easily treatable, it is usually asymptomatic and often leads to lethal complications if left untreated. The prevalence of HTN is increasing rapidly in India driven by diverse health transitions. Apart from health implications it has huge societal, developmental and economic costs to resource constrained health systems, particularly developing nations like India. Further, hypertension is also a leading cause for hospitalizations and outpatient visits.
Reducing systolic and diastolic BP can decrease cardiovascular risk and this can be achieved by non-pharmacological (lifestyle measures) as well as pharmacological means (medicines). Homoeopathic system of medicine particularly individualized constitutional approach has significant beneficial effects on patients suffering from HTN and thus widely used in length and breadth of our nation as an alternative public health approach in curbing the increasing prevalence of HTN because of its cost effectiveness and minimal side effects.
In current scenario with rising burden of HTN posing a serious health threat to health care system of India, the present article makes a sincere attempt to present before its readers how to timely and effectively address a case of HTN at primary level health care set-up with homoeopathic medicines.
Author : The author has done her post-graduation from National Institute of Homoeopathy, Kolkata in the subject Homoeopathic Repertory. She is presently working as Medical Officer in Dept. of ISM &Homoeopathy under Govt. of NCT Delhi.
E-mail id: smita.brahmachari@rediffmail.com.
1. General anaesthesia can have both direct and indirect effects on the immune system by impacting the innate immune response, adaptive immune response, cytokine production, neutrophil activity, and immunoglobulin levels.
2. Surgery alone increases pro-inflammatory cytokine levels, but anaesthetic agents may increase or decrease specific cytokine production depending on the agent.
3. Perioperative interventions like mechanical ventilation, blood transfusions, chronic pain, and immunosuppressive drugs for transplant patients can further impact the immune response. Precautions are needed for patients with these factors.
This document discusses supraglottic airway devices in children. It provides a history of the first supraglottic device, the LMA, introduced in 1988. It defines supraglottic devices and classifies them based on sealing mechanisms and generation. The document discusses indications, contraindications, advantages, and limitations of supraglottic devices in children. It provides details on insertion and placement of LMAs and describes different types of LMAs including the classic LMA, ProSeal LMA, flexible LMA, i-gel, and air-Q intubating laryngeal airway.
This document discusses intraoperative hypoxemia. It defines hypoxemia and classifies its causes. Causes are problems with oxygen delivery systems like ventilators, circuits or endotracheal tubes. Or problems with patients like reduced lung volumes, atelectasis or increased oxygen demand. Specific risk factors are discussed like obesity, pregnancy, elderly and one lung ventilation. Diagnosis involves monitoring like pulse oximetry. Management focuses on giving high oxygen, ventilation support and treating underlying causes. Prevention emphasizes machine checks and safety features.
This document discusses hypertensive emergencies and urgencies. It defines hypertensive emergency as severe hypertension with acute end-organ damage, requiring rapid BP reduction over hours. Hypertensive urgency is severe hypertension without acute end-organ damage, allowing BP control over days to weeks. The main organs affected are the brain, heart, and kidneys. Initial treatment involves evaluating for end-organ damage and relaxing the patient before considering IV antihypertensives. Goals are to lower BP by 25% over the first hour while maintaining organ perfusion. Specific treatments depend on the damaged organ system. Follow-up after discharge assesses for ongoing hypertension management.
Hypertension, or high blood pressure, is one of the most common diseases worldwide. It is a major risk factor for heart disease and stroke. The document discusses the definition, classification, evaluation, causes, treatment, and prevention of hypertension. Prevention strategies recommended by WHO include reducing salt intake, maintaining a healthy weight, regular exercise, stress reduction, not smoking, and modifying lifestyle behaviors. Treatment aims to lower blood pressure below 140/90 mmHg through lifestyle changes and lifelong medication if needed.
Hypertension, or high blood pressure, is defined based on average readings from multiple visits. It is classified by the WHO into normal, prehypertension, and stages 1 and 2 hypertension. Primary hypertension has no identifiable cause while secondary hypertension has identifiable underlying causes. Complications arise from damage to blood vessels and target organs like the brain, heart, kidneys, and eyes. Treatment involves lifestyle modifications and medications like diuretics, ACE inhibitors, calcium channel blockers, and beta-blockers. Care must be taken with anesthesia as patients can experience exaggerated blood pressure changes in response to stimuli. Antihypertensive medications should generally be continued during surgery.
The document discusses hypertensive emergencies, which are severe hypertension with acute impairment of an organ system. It defines different categories of hypertension and provides case examples. It covers the etiology, pathophysiology, symptoms, workup, and treatment of hypertensive emergencies. Treatment involves rapidly lowering blood pressure over minutes to hours for patients with end-organ damage, while those without can have blood pressure controlled over days to weeks. Intravenous medications like nitroprusside, labetalol, and nicardipine are used for rapid blood pressure reduction in emergencies.
This document discusses hypertension, including definitions, types, causes, diagnosis, treatment and goals. It defines hypertension as a blood pressure over 140/90 mmHg based on multiple readings. Types include primary (essential) hypertension which is most common, and secondary hypertension which has an identifiable underlying cause. Causes of secondary hypertension include renal, endocrine and vascular diseases. Treatment involves lifestyle changes and may include diuretics, ACE inhibitors, calcium channel blockers, and other classes of medications. Goals are under 140/90 mmHg for most patients, though higher for some groups. Combination drug therapy is often needed to achieve blood pressure control.
Hypertension, or high blood pressure, is defined as a systolic blood pressure above 140 mmHg or a diastolic blood pressure above 90 mmHg. It can be classified based on severity from stage 1 to stage 2. Primary causes include sympathetic nervous system hyperactivity, renin-angiotensin system activity, and defects in natriuresis. Target organ damage may occur in the eyes, heart, brain, kidneys, and vasculature. Hypertensive emergencies require rapid blood pressure reduction to prevent end organ damage and include hypertensive encephalopathy and eclampsia. Intravenous drugs like sodium nitroprusside, labetalol, and hydralazine are used to slowly
This document discusses hypertension (high blood pressure) including its causes, effects on the heart, treatment targets, and drug treatment options. It notes that primary hypertension accounts for 90-95% of cases and outlines trial findings showing benefits of tight blood pressure control, especially in patients with diabetes. Treatment involves lifestyle changes and medications, typically starting with diuretics, with the goal of controlling blood pressure to under 140/85 mmHg.
This document discusses the management of hypertensive emergencies and urgencies. It defines hypertensive emergencies as marked blood pressure elevation with acute life-threatening organ damage, requiring rapid BP reduction in an ICU. Hypertensive urgencies involve significant but not life-threatening BP elevation without acute organ dysfunction, allowing gradual oral medication-based BP reduction over hours. The document reviews ideal intravenous antihypertensive agents, special considerations for neurological, cardiovascular and other emergencies, and the treatment of hypertensive urgencies.
Hypertensive crisis refers to severely elevated blood pressure that can lead to organ damage and is categorized as hypertensive urgency or emergency depending on the presence of end-organ damage; treatment of urgency involves gradual oral medication while emergency requires immediate intravenous drugs to reduce blood pressure to prevent further damage; careful diagnosis and monitoring of blood pressure and organs is needed along with selecting appropriate drugs based on the situation.
hypertension anesthesia, general management. antihypertensive pharmacologyAbayneh Belihun
This document outlines a presentation on hypertension given at Aksum University in February 2016. It discusses the significance of hypertension for anesthetists, including how familiarity with antihypertensive drugs is important. It also notes that hypertension commonly occurs during anesthesia and its recognition depends on correctly functioning monitors. The document provides definitions of hypertension and outlines its classification, as well as general management approaches including non-pharmacological and pharmacological treatment. It discusses various drug classes used to treat hypertension and their mechanisms of action.
Hypertension, or high blood pressure, is caused by increased cardiac output and peripheral vascular resistance. It is classified as essential (primary) hypertension which is idiopathic or secondary which has an identifiable cause. Risk factors include family history, race, stress, obesity, sodium intake, alcohol, and tobacco use. Complications affect the heart, brain, kidneys and eyes. Diagnosis involves medical history, physical exam, and tests like ECG and bloodwork. Treatment focuses on lifestyle modifications and may include diuretics, beta blockers, ACE inhibitors, and other medications. Nursing care educates on compliance, diet, exercise and monitoring.
This document discusses hypertension (high blood pressure). It defines hypertension as a systolic blood pressure over 140 mm Hg or a diastolic over 90 mm Hg. It classifies blood pressure levels and discusses the causes, risk factors, diagnosis, and management of hypertension through lifestyle modifications and pharmacological treatments. Specific populations discussed include those with diabetes, pregnancy, children, emergencies, and geriatrics. The goal is to treat hypertension to reduce risks of heart disease and stroke through safe and effective medical care.
1. The document discusses cardiovascular pharmacology, focusing on drugs used to treat hypertension and heart failure.
2. Several classes of antihypertensive drugs are described, including diuretics, beta-blockers, ACE inhibitors, calcium channel blockers, and vasodilators.
3. Drugs used to treat heart failure that are mentioned include diuretics, ACE inhibitors, beta-blockers, and vasodilators.
This document provides an overview of antihypertensive drugs and diuretics. It begins with definitions of hypertension and classifications of blood pressure. It then discusses mechanisms of controlling blood pressure, including the baroreflex and renin-angiotensin-aldosterone system. The rest of the document covers classifications and mechanisms of various classes of antihypertensive drugs and diuretics, along with their therapeutic uses, pharmacokinetics, and adverse effects. These classes include ACE inhibitors, beta blockers, calcium channel blockers, and diuretics. The document also addresses resistant hypertension, hypertensive emergencies, and use of antihypertensives during pregnancy.
Advance therapy in hypertension... jyoti..pptJyoti Sharma
This document discusses hypertension and its treatment. It begins by defining hypertension and describing its various classifications and categories based on systolic and diastolic blood pressure readings. It then discusses the effects of hypertension on the body and the mechanisms involved, including the renin-angiotensin system. Causes of resistant hypertension and classifications of oral antihypertensive agents are provided. The document concludes by outlining investigations into new therapies for hypertension, such as guanylate cyclase stimulators, prostacyclin receptor agonists, endothelin receptor blockers, and endothelial nitric oxide synthase couplers.
Hypertension, or high blood pressure, is defined as a systolic blood pressure over 140 mm Hg or a diastolic blood pressure over 90 mm Hg. It can be caused by primary or secondary factors and is a major risk factor for cardiovascular disease. Treatment involves lifestyle modifications like diet, exercise, and weight loss as well as pharmacological therapies including diuretics, ACE inhibitors, calcium channel blockers, and others. Management may differ in special populations such as pregnant women, children, the elderly, and those with diabetes or kidney disease.
A presentation hypertension
(what blood pressure is, what is hypertension, what are the risk factors of hypertension, how is it managed?) and other related knowledge on hypertension
Similar to Hypertension , crf post renal transplant patient for surgery (20)
Robotic surgeries are becoming most popular in field of surgical departments due to its precision of hand in many cancer surgeries. Anaesthesia in these places are quite challenging due to lack place to move , a meticulous vigilance is always required for safety of patient and conduct safe Anesthesia
Telemedicine is a upcoming topic of interest, especially in pandemic times where remote places cannot be assesed telemedicine is a great oppurtunity in such circumstances.
anesthesia through telemedicine is possible.
Tourniquets are used in surgery to reduce blood loss by restricting blood flow to the limb. They were introduced in the 1700s and modern pneumatic tourniquets were developed in the early 1900s. Tourniquets can cause nerve injury, muscle damage, and systemic effects if not used properly. The duration of inflation should be limited to 90 minutes to prevent complications. Precise pressure and monitoring are needed to safely use tourniquets.
Dr. T. Kumar presented on scavenging systems for removing trace levels of anesthetic gases in operating rooms. Scavenging systems use active or passive methods to collect and remove excess anesthetic gases through the room ventilation system. Proper scavenging can reduce ambient gas levels by up to 90%. Key components of scavenging systems include gas collection, transfer tubing, interfaces, disposal tubing, and disposal methods like central evacuation or room ventilation. Regular maintenance and equipment checks along with careful anesthesia techniques are needed to minimize waste gases and exposure risks for operating room staff.
Dr. Kumar presented on renal replacement therapy. The key points are:
1. Approximately 5% of critically ill patients with AKI will require RRT, with a mortality rate as high as 60%.
2. RRT options include intermittent HD, continuous therapies like CVVH/CVVHD/CVVHDF, and SLED.
3. The choice of RRT depends on the patient's cardiovascular status, resources available, and whether fluid removal or solute clearance is required. CRRT is preferred for hemodynamically unstable patients.
Pheochromocytoma and its anaesthetic managementDr Kumar
This document discusses pheochromocytoma, including its epidemiology, clinical presentation, diagnosis, and management. Key points include: Pheochromocytomas are rare neuroendocrine tumors that secrete excess catecholamines. Common symptoms include headaches, sweating, palpitations, and hypertension. Diagnosis involves biochemical testing of urine or plasma catecholamines/metabolites and imaging such as CT, MRI, or MIBG scan. Preoperative management focuses on alpha- and beta-blockade to control blood pressure and symptoms prior to surgical resection.
Dr. Kumar presented on extubation problems and their management. Some key points:
1. Tracheal extubation requires careful planning and preparation to prevent complications like laryngospasm, laryngeal edema, and pulmonary aspiration.
2. Patients should generally be extubated awake to allow for airway protection, but deep extubation may be considered to reduce cardiovascular stimulation.
3. Potential problems include mechanical issues removing the tube, cardiovascular changes, respiratory complications, and airway obstruction. Management depends on the specific issue but may include medications, positioning, or alternative extubation techniques.
4. Careful evaluation of each patient's risk factors and planning is necessary to safely perform extubation and prevent
Buffers in the body resist changes in pH and maintain it within a narrow range. The major buffer systems are bicarbonate, phosphate, and proteins. Bicarbonate buffers work by absorbing excess hydrogen ions in the blood and tissues. The kidneys and lungs work together to control bicarbonate and carbon dioxide levels to regulate pH. When an acid is added, buffers prevent a large change in pH by neutralizing the hydrogen ions.
Anaesthesia for interventional neuroradiologyDr Kumar
The document provides information on anaesthesia for interventional neuroradiology procedures. It discusses:
1. The indications for anaesthesia including maintaining immobility, rapid recovery, managing anticoagulation, and treating complications.
2. Pre-operative assessment considerations like pulmonary and cardiovascular risks in subarachnoid hemorrhage patients.
3. Techniques for induction, maintenance and recovery from anaesthesia aimed at maintaining stability while allowing the procedure, including use of propofol, remifentanil and sevoflurane.
4. Managing risks like hypertension, hypotension and temperature during the procedure.
This document discusses ambulatory and fast track anesthesia. It covers topics such as the benefits of ambulatory surgery including lower costs and greater efficiency. It describes different facility designs for ambulatory surgery and lists many common procedures that can be done on an outpatient basis. The document outlines considerations for patient selection and preoperative preparation including pharmacologic and non-pharmacologic techniques. It also discusses various anesthetic techniques for ambulatory surgery like general anesthesia, regional anesthesia, and monitored anesthesia care. Fast tracking approaches to minimize side effects like PONV are also summarized.
Dr. Kumar presented on acute pain management. He discussed how acute pain is initiated by nociceptors and transmitted through three neurons to the brain. Poorly managed acute pain can lead to central sensitization and chronic pain. He described the anatomy and pathways of acute pain transmission, including modulation by descending pathways. Drugs like opioids, NSAIDs, ketamine, alpha-2 agonists, and gabapentinoids were discussed as treatment options, as well as patient-controlled analgesia and regional anesthesia techniques.
2. HYPERTENSION
Defintion :
“An adult is considered to be
hypertensive when systemic BP>140/90
mm Hg or more on atleast two
occasions measured at least 1or2
weeks apart.”
5. Essential Hypertension
95% of all cases of hypertension
characterized by a familial incidence and
inherited biochemical abnormalities.
6. Factors causing Genesis
increased sympathetic nervous system activity in
response to stress
overproduction of sodium-retaining hormones and
vasoconstrictors
high sodium intake
inadequate dietary intake of potassium and
calcium
increased renin secretion
deficiencies of endogenous vasodilators such as
prostaglandins and nitric oxide (NO)
the presence of medical diseases such as
diabetes mellitus and obesity
7. Additional factors
Genetic factors
1.Glucocorticoid remediable HTN:
2.Syndrome of apparent
mineralocorticoid excess
Alcohol and tobacco use
Obstructive sleep apnea
Physical activity
10. 2.Secondary Hypertension
37
JNC VII Causes of Secondary HypertensionJNC VII Causes of Secondary Hypertension
Medical Conditions
Sleep apnea
Thyroid or parathyroid disease
Aortic coarctation
Pheochromocytoma
Cushing’s syndrome
Chronic steroid therapy
Renovascular disease
Primary hyperaldosteronism
Chronic kidney disease
Drugs
Alcohol
Cocaine or amphetamines
Ephedra, mu huang, bitter orange
Erythropoietin
Cyclosporine or tacrolimus
Sympathomimetics
Adrenal steroids
Oral contraceptives
NSAIDS
Chobanian AV et al. JAMA. 2003;289:2560-2572
NSAIDS=Non-steroidal anti-inflammatory drugs
11. Isolated systolic Hypertension
Aging with associated aortic rigidity
Increased cardiacoutput
a. Thyrotoxicosis
b. Anemia
c. Aortic regurgitation
Decreased peripheral vascular resistance
a. Arteriovenous shunts
b. Paget's disease
12. Treatment of Essential
Hypertension
GOALS
to decrease systemic blood pressure to lower than 140/90
mm Hg, but in the presence of diabetes mellitus or renal
disease, the goal is lower than 130/80 mm Hg
decreasing the incidence of cerebrovascular accidents
decreases the morbidity and mortality associated with
ischemic heart disease
prevents progression to a more severe stage of
hypertension and decreases the risk of congestive heart
failure and renal failure.
13. LIFE STYLE MODIFICATION-
Patients who do not manifest clinical evidence of
cardiovascular disease or target organ damage
may benefit from a trial of lifestyle modification
PHARMACOLOGICAL THERAPY
-Patients with concomitant risk factors
(hypercholesterolemia, diabetes mellitus, tobacco
abuse, family history, age older than 60 years)
and
-evidence of target organ damage are most likely
to benefit from pharmacologic antihypertensive
therapy
14.
15.
16. Treatment of Secondary
Hypertension
Surgical Therapy:
1. correction of renal artery stenosis via
angioplasty or direct repair and
2. adrenalectomy for adrenal adenoma or
pheochromocytoma
Pharmacologic Therapy:
renal artery revascularization is not possible
blood pressure control with ACE inhibitors alone
or in combination with diuretics.
Renal function and serum potassium
concentration must be carefully monitored
17. Hypertensive Crises
Definition:
Hypertensive crises typically present with a blood
pressure of higher than 180/120
categorized as
1. hypertensive urgency
2. hypertensive emergency
based on the presence or absence of impending
or progressive target organ damage
18. Hypertensive Emergency
evidence of acute or ongoing target organ damage
1. encephalopathy,
2. intracerebral hemorrhage,
3. acute left ventricular failure with pulmonary edema
4. unstable angina,
5. dissecting aortic aneurysm
6. acute myocardial infarction,
7. eclampsia,
8. microangiopathic hemolytic anemia,
9. renal insufficiency
require prompt pharmacologic intervention to
lower the systemic blood pressure
19. Treatment
goal of treatment to decrease the diastolic blood
pressure promptly but gradually
A precipitous decrease in blood pressure to
normotensive levels may provoke coronary or
cerebral ischemia
Typically, mean arterial pressure is reduced by about
20% within the first 60 minutes and then more
gradually.
Thereafter, the blood pressure can be reduced to
160/110 over the next 2 to 6 hours as tolerated by the
20. Hypertensive Urgency
Hypertensive urgencies are situations in which
BP is severely elevated, but the patient is not
exhibiting evidence of target organ damage.
These patients can present with headache,
epistaxis, or anxiety.
Selected patients may benefit from oral
antihypertensive therapy
21.
22.
23. Management of Anesthesia in
Patients with Essential Hypertension
Pre operative evaluation:
1. Determine adequacy of blood pressure control
2. Review pharmacology of drugs being
administered to control blood pressure
3. Evaluate for evidence of end-organ damage
4. Continue drugs used for control of blood
pressure
24. review the pharmacology and potential side effects of the
drugs being used for antihypertensive therapy
hemodynamic instability and hypotension will occur during
anesthesia in patients receiving ACE inhibitors
discontinue ACE inhibitors 24 to 48 hours preoperatively in
patients at high risk of intraoperative hypovolemia and
hypotension.
ARBs increases the potential for hypotension during
anesthesia.
necessitating use of vasopressin or one of its analogues
25. risk of rebound hypertension should certain drugs,
especially β-adrenergic antagonists and clonidine,
be abruptly discontinued.
Hypokalemia (<3.5 mEq/L) despite potassium
supplementation is a common preoperative finding in
patients being treated with diuretics.
Hyperkalemia can be seen patients being treated
with ACE inhibitors
26. Induction of Anesthesia
Hypotension during induction in patients continuing
ACE inhibitor or ARB therapy.
Direct laryngoscopy and tracheal intubation can
produce significant hypertension in patients with
essential hypertension
deep inhalation anesthesia or injection of an opioid,
lidocaine, β-blocker, or vasodilator protect from MI
Direct laryngoscopy that does not exceed 15
seconds in duration helps minimize blood pressure
27. Maintenance of Anesthesia
to minimize wide fluctuations in blood pressure.
Management of intraoperative blood pressure
lability is as important as preoperative control of
hypertension in these patients.
Problems
1. Intraoperative hypertension
2. Intraoperative hypotension
28. 1. Intraoperative hypertension
produced by painful stimulation, i.e., light anesthesia
A nitrous oxide–opioid technique can be used for
maintenance of anesthesia
Antihypertensive medication by bolus or by
continuous infusion is an alternative to the use of a
volatile anesthetic for blood pressure control
intraoperatively
no evidence that a specific neuromuscular blocker is
best for patients with hypertension
29. Intraoperative Hypotension
Hypotension during maintenance of anesthesia may
be treated by decreasing the depth of anesthesia
and/or by increasing fluid infusion rates.
Cardiac rhythm disturbances that result in loss of
sequential atrioventricular contraction such as
junctional rhythm and atrial fibrillation can also create
hypotension
ephedrine or phenylephrine may be necessary to
restore vital organ perfusion pressures
patients treated with ACE inhibitors or ARBs is
responsive to administration of i.v fluids or
vasopressin.
30. Postoperative Management
Postoperative hypertension is common in patients
with essential hypertension.
assessment and treatment to decrease the risk of
myocardial ischemia, cardiac dysrhythmias,
congestive heart failure, stroke, and bleeding.
conversion can be made to the patient's usual
regimen of oral antihypertensive medication
31. Chronic Renal Failure
CRF occurs where GFR has been reduced to 10%
(20ml/min) of normal function and ESRD when GFR falls
below 5% (10ml/min).
The relationship between serum creatinine and GFR is
not linear (figure 1) and serum creatinine does not rise
until GFR has fallen below 50%.
32. Stages of Chronic Kidney Disease
(NKF,2003)
Stage Description GFR
1 Kidney Damage with
normal GFR
>/=90
2 Kidney Damage with
mild fall in GFR
60-89
3 Moderate fall in GFR 30-59
4 Severe fall in GFR 15-29
5 Kidney Failure <15
34. ESRD AGE >18Yrs
Type 1 D.M.
Chr. G.N.
Type 2 D.M.
Hypertensive N.S.
MPGN
Obstructive uropathy
Ig A Nephropathy
SLE
Others 21.6
35. Pathophysiologic
consequences
Cardiovascular
Hyper tension develops in approximately 80%
patients
Sodium and water retention, hyper secretion of renin
– high conc. of renin, angiotensin-װ and
aldosterone with LVH, hypertensive
cardiomyopathy, hypertensive crises
Ischemic heart disease
36. Cardiovascular
Atherosclerosis and vascular calcification (high
calcium&phosphate product).
Uremic pericarditis if untreated leads to cardiac
tamponade & later constrictive pericarditis.
Dysrhythmias due to Hyperkalemia and
hypocalcaemia.
37. Haematological effects
Anaemia
Due to decreased erythropoietin production,
Diminished erythrocyte survival,
Diminished production of R.B.C’s due to fibrosis of
bonemarrow.
Reduced dietary intake and absorption of iron.
Fragility of capillaries
Qualitative dysfunction of platelets due to decreased
platelet factor III activity.
Aluminium toxicity & iron,folate,vitB6,B12.
38. Haematological effects
Absence of correction of the anaemia,there are
compensatory mechanisms for the reduction in
oxygen carrying capacity .
increase in cardiac output & an increase in the
2,3DPG.
Severe anaemia affects the blood-gas partition
coefficient so onset & recovery is faster .
39. Respiratory system
Pulmonary congestion & edema are seen with
resultant hypoxaemia & hypocapnia .
Intra peritoneal fluid causes diaphragmatic splinting
with basal atelectasis & shunting.
Uremia can cause pleuritis.
Immunosuppressed patients are more susceptable
to pulmonary infections .
41. Electrolyte and fluid
disturbances
Uremic patients tolerate hyperkalaemia & it is
safe to administer anaesthesia in the presence of
higher K levels,unless there are ECG changes.
Methods for preoperative correction include
glucose-insulin,sodium bicarbonate ,10ml of 10%
of calcium gluconate,hyperventilation ,furosemide
or dialysis & kayexilate .
42. Endocrine
Secondary hyperparathyroidismosteomalacia,
renal osteodystrophy (bone pain, fractures),
Insulin half life is prolonged in CRF, due to
decreased tubular metabolism of insulin.
However there is post receptor defect in insulin
action, and relative insulin resistance.
Hyperprolactinaemia – loss of libido in both sexes,
amenorrhea in women.
43.
44. Coagulation
Several abnormalities of coagulation factors like(dec plat
F III, platelet dysfn).
Pletelet FIII decreased because of accumulation of toxic
waste products,
These products are removed by dialysis.
Other methods platelet , cryoprecipitate &
desmopressin acetate .
Desmopressin acetate increase the activity of factors
VIII,XII,von willebrand factor.
45. Central nervous system
Features of uremia are initially malaise & reduced
mental ability.
Others are seizures,coma & death .
Dialysis associated with dysequilibrium syndrome.
Due to sudden changes in extracellular
volume,electrolytes & cerebral edema.
Presents as dehydration,weakness,
vomiting,hypotension ,convulsions & coma.
46. Peripheral neuropathy
Demyelination of medullated fibres, long fibres
are involved earlier.
Sensory neuropathy: paraesthesia.
Motor neuropathy: foot drop.
Uremic autonomic neuropathy: postural
hypotension, diarrhea.
47. Myopathy
A combination of poor nutrition,
hyperparathyroidism, Vit.D deficiency and
disorders of electrolyte metabolism.
Muscle cramps are common & quinine sulphate
will be helpful.
Restless leg syndrome patients legs are jumpy
during the night which is improved by
clonazepam .
48. Gastrointestinal tract
Presents with anorexia,nausea &vomiting,GI bleed &
diarrhoea .
Delayed gastric emptying,increase in acidity &
gastric volume .
Pt benefits from administration of histamine H2
receptor antagonist as a premedication .
Ascites is a rare but important complications .
49. Immune system
Uremia impairs normal immune mechanisms .
It is obtunded further by giving
immunosuppresant therapy
As a result sepsis remains a major prob.
So strict aseptic technique is followed .
50. altered drug handling in CRF
volume of distribution is usually decreased, but
may be increased if there is fluid retention
Hypoalbuminaemia and acidosis increase the
free drug availability of highly protein bound drugs
The doses of benzodiazepines and thiopentone
may need to be reduced by 30% - 50%
The elimination of highly ionised, water soluble
drugs such as atropine are partially or completely
dependent on renal excretion and may be
markedly reduced.
51. The elimination of volatile anaesthetic agents is not
dependent on renal function and their activity is
unaffected by CRF.
The hepatic metabolism of both enflurane and
sevoflurane will produce nephrotoxic fluoride ions and
their use should be discouraged for prolonged durations
Atracurium and cisatracurium are obvious choices for
muscle relaxation.
The excretion of anticholinesterases and anticholinergic
agents will be prolonged as they are highly ionised and
water soluble.
Avoid NSAIDS
52. POST TRANSPLANT STATE
A chronic kidney disease - continued organ
dysfunction
Post transplant surgery frequency is ~ 41%
Surgery unrelated to transplant ~ 6%
Incidence and urgency of surgery does not vary
with the source of donor kidney
Mortality related to the degree of
immunosuppression and not additional operation.
53. Problems In Post Renal transplant
1. Persistent cardiovascular disease
2. Bone disorders
3. Electrolyte and acid base
imbalance
4. Post transplant Diabetes Mellitus
5. Malignancy
6. Infection
54. 1. CARDIOVASCULAR DISEASE
Most common cause of mortality in those
with functional grafts – 30-40%
Increased incidence of : coronary heart
disease, CHF, ventricular hypertrophy,
hypertension, cerebrovascular disease,
peripheral vascular disease.
59. 2. BONE DISORDERS
HYPERPARATHYROIDISM
Very common in 1st post transplant
year
Risk factors –
Degree of pre- transplant disease
Duration of dialysis
Contributing factors-
Deficiency of vitamin D
Poor allograft function
60. BONE DISORDERS –
HYPERPARATHYROIDISM contd.
Symptoms – mostly asymptomatic
Dx – increased plasma Ca
decreased plasma phosphate
Rx – vitamin D analogs (stopped if S
Ca.>11mg/dl )
- phosphate supplements
61. BONE DISORDERS - HYPERPARATHYROIDISM
contd.
Surgery – indications –
1) severe symptomatic hypercalemia in early post
transplant period
2) persistent moderately severe hypercalcemia for
> one year post transplantation
Surgery done – subtotal parathyroidectomy
62. 2. BONE DISORDERS
GOUT
Cyclosporine – most
important cause
Impairs renal uric acid
clearance
Rx –
Colchicine
High dose steroids
Synthesis inhibitor i.e.
Allopurinol ( dec. dose of
azathioprine)
NSAIDS – Avoid
64. 2. BONE DISORDERS
OSTEOPOROSIS
Common bone disorder- parallel reduction in bone
mineral and bone matrix→ Decreased bone mass
Maximum bone loss – first 6 month
65. BONE DISORDERS –
OSTEOPOROSIS contd.
Causes
Steroids
Ongoing hyperparathyroidism
Vit D def /resistance
Phosphate depletion
Rx
Weight bearing exercise
Steroid minimization
Elemental calcium and calcitriol
Clinical implication – Increased risk of fracture
67. ELECTROLYTE IMBALANCE contd.
HYPOPHOSPHATEMIA
Due to excess urinary excretion
residual hyperparathyroidism
Glucocorticoids
low Vit D state
Implication – Profound respiratory muscle weakness
68. ELECTROLYTE IMBALANCE contd.
HYPERCALCEMIA
Causes –
Persistent Hyperparathyroidism
Co- administration of calcium and vit D
Implication – shortened Q-T interval and
arrhythmias
69. ELECTROLYTE IMBALANCE contd.
HYPOMAGNESEMIA
Cause - CNI induced
Asymptomatic
Rx – magnesium supplements if plasma Mg levels <
1.5mg/dl
Clinical implication - ↑ risk of perioperative
arrhythmias, impaired respiratory muscle power
70. ACID BASE IMBALANCE
METABOLIC ACIDOSIS
Causes
Distal (hyperchloremic) renal tubular acidosis -
occurs due to:
CNI
Rejection
Residual hyperparathyroidism
Clinical Implication - intraoperative electrolyte
imbalance
prolonged NM blockade
interference with drug PK
71. 4. POST TRANSPLANT DIABETES
MELLITUS
New onset DM –
Common
Increased CV risk
Risk factors –
Older age
Obesity
Positive hepatitis C
antibody status
Family history
Deceased donor
allograft
Steroids
CNI
Episodes of acute
rejection
72. POST TRANSPLANT DM (contd)
Rx
Steroids minimized
Tacrolimus avoided
Oral hypoglycemic drugs and Insulin
Metformin- most effective
73. 5.MALIGNANCY
Causes of ↑ cancer incidence –
Immunosuppressants → inhibit normal tumor
↓ surveillance
mechanisms
uncontrolled proliferation
of oncogenic viruses
Factors related to primary renal disease ( analgesic
abuse, HBV , HCV, certain herbal preparations)
Renal cystic disease
74. MALIGNANCY contd.
Treatment
↓ the dose of immunosuppression
Sirolimus – increasing evidence of
antineoplastic effects
Post Transplant Lymphoproliferative Disorder
(PTLD)
1-2% incidence
Feared complication
Cause- Infection and transformation of B cell by
EBV
75. INFECTIONS (contd.)
0-1 MONTH - ~ to those seen in non transplant
patients after surgery.
UTI
lung infections
related to vascular catheters
Bacterial> fungal
77. INFECTIONS (contd.)
> 6 MONTHS – risk of infection decreases
can be divided into 2 groups –
1) Good graft function, no need of late
supplemental immunosuppression – infection
risk similar to general population
2) Poor graft function, received large cumulative
doses of immunosuppression – remain at risk of
oppurtunistic infection
-need long term SMX- TMP prophylaxis
78. INFECTIONS (contd.)
Clinical implication –
Minimizing infection should be the goal
Require meticulous surgical technique
Antiviral prophylaxis
Avoidance of excess immunosuppression
79. Common surgical indications
First 48 hrs of transplant:
Rexploration for bleeding/reduced urine/thrombosis
of graft
Late presentations:
Graft failure: Redo surgery
Uncontrolled hypertension-- Nephrectomy
Lymphoceles, Wound infections
Joint replacements (renal osteodystrophy,
steroid)
Cesarean Sections
GI bleed, CABG, dental (gum hyperplasia)
80. Anesthetic challenges &
preoperative assessment
Avoidance of infection: Maintain sterility
Signs of intra-abdominal sepsis..often absent
fever, leukocytosis, peritonitis signs absent
Assess/Preserve graft function:
previous episodes of rejection
BU, S.Cr, SE (Na,K,Ca,Mg)
Avoid nephrotoxic drugs
86. Monitoring
Perioperative monitoring: risk/benefit
type of surgery
anesthesia planned
equipment available
CVP monitoring:
Transplanted kidneys sensitive to hypovolemia
Diuretic use: adequate intravascular volume
urine output
87. Technique
General (balanced & TIVA) as well as regional
successfully used
General anaesthesia
Nasal intubation better avoided
Use of LMA acceptable
Ketamine: cautious in HTN/CAD
89. Muscle relaxants
Atracurium, Cisatracurium usually preffered
Vecuronium should be prevented –reno
vasoconstriction
Delayed gastric emptying/RSI:
Sch: K<5.5 meq/L
Rocuronium, miva
90. Analgesia
Avoid NSAIDS:
GI Hmge, nephrotoxicity
Augment Cyclosporine A nephrotoxicity
Opiate analgesics often used
Meperidine,M3G and M6G: prolonged sedation
Remifentanyl@ 0.1-0.5 mics/kg/min:
short acting
Non specific tissue and plasma esterases
92. POST OP CARE
PAIN –
Opioid based pain relief
Morphine , pethidine – avoid if RFT deranged
Paracetamol - in paediatric patients
NSAIDS to be avoided
Epidural analgesia
93. POST OP CARE
Cardiovascular collapses have occured upto 2
days post op.
All monitoring should be continued till 2nd post op
day.
In patients with CV disease :
Perioperative beta blockers – can be considered
Maintain normothermia
Haematocrit > 30%
Adequate analgesia
Editor's Notes
Sirolimus – so used in recipients who develops cancer