Crisis management during anaesthesia: hypertension.

Area of Science:

• Anesthesiology
• Cardiovascular Medicine
• Patient Safety

Background:

• Hypertension is a common complication during anesthesia, requiring prompt management.
• Inadequate monitoring or delayed treatment can lead to significant patient morbidity and mortality.
• Effective recognition and treatment rely on accurate and calibrated monitoring equipment.

Purpose of the Study:

• To evaluate a structured algorithm, "COVER ABCD-A SWIFT CHECK," for managing intraoperative hypertension.
• To assess the algorithm's effectiveness when supplemented with a specific sub-algorithm for anesthetic-associated hypertension.

Main Methods:

• The study analyzed the first 4000 incidents reported to the Australian Incident Monitoring Study (AIMS).
• The proposed algorithm's performance was retrospectively compared against the actual management of 70 intraoperative hypertension cases.
• The comparison focused on the potential impact of the structured approach on incident resolution.

Main Results:

• Drug-related causes were identified as the source of hypertension in 59% of the reported incidents.
• The structured algorithm was predicted to lead to a quicker or better resolution in 21% of the analyzed cases.
• The analysis highlighted the importance of structured protocols in managing anesthetic-related hypertension.

Conclusions:

• Prompt control of identified hypertension using volatile anesthetics, opioids, or rapid-acting antihypertensives typically prevents severe morbidity.
• Unusual causes like phaeochromocytoma, carcinoid syndrome, or thyroid storm should be considered for treatment-resistant hypertension.
• The study supports the use of structured algorithms for consistent and effective management of intraoperative hypertension.