Cardiovascular anesthetic complications and treatment in oral surgery

Area of Science:

• Anesthesiology
• Cardiology
• Critical Care Medicine

Background:

• Perioperative hypertension is a frequent clinical challenge.
• Untreated hypertension increases risks of myocardial infarction and stroke.
• Limited antihypertensive medication options are available for office settings.

Purpose of the Study:

• To review the management of perioperative hypertension and hypotension.
• To discuss appropriate therapeutic strategies for blood pressure fluctuations during the perioperative period.

Main Methods:

• Literature review of perioperative blood pressure management.
• Analysis of treatment guidelines for hypertension and hypotension.
• Discussion of pharmacological and non-pharmacological interventions.

Main Results:

• Most office-based hypertensive episodes are urgencies, not emergencies, requiring cautious management.
• Aggressive antihypertensive therapy is generally not indicated for urgencies.
• Hypotension management involves decreasing anesthesia depth, IV fluids, and vasopressors (ephedrine, phenylephrine) if mean arterial pressure < 60 mm Hg.

Conclusions:

• Perioperative blood pressure management requires careful consideration of urgency versus emergency.
• Treatment strategies should be tailored to the specific clinical scenario.
• Prompt management of hypotension is crucial to prevent end-organ damage.