Hypertension in the post-operative cardiothoracic patient
High blood pressure can also be a major problem in this population. This issue was explored in Question 10 from the first paper of 2008.
Why, you ask?
- Increased bleeding risk - particularly from the aortic cannulation site
- Extension of an arterial dissection
- Increased afterload and thus increased LV workload
- Thus, increased risk of ischaemia
- Increased risk of cardiac failure due to decompensated LV failure
- Increased stress on grafted valves or repaired aortic root
- Worsening of existing mitral regurgitation
- Increased need for sedation
- Bleeding from aortic cannulation site
Causes of hypertension in the post-cardiothoracic surgical patient
- Inadequate sedation in a partially paralysed patient
- Pre-existing hypertension, and the perioperative cessation or regular medications
- Artifactual hypertension (measurement error)
- Unintelligent use of vasopressors
- The sudden improvement of aortic flow following the repair of a stenotic aortic valve, which exposes the systemic circulation to being bullied by a massively hypertrophied left ventricle.