Postoperative hypertension associated with radical neck dissection

The incidence of hypertension following radical neck dissection was examined in 94 consecutive patients. Nine patients (9.6%) had postoperative blood pressure readings of 200/100 mm Hg or higher (n = 4) or of more than 40 mm Hg systolic and more than 20 mm Hg diastolic above preoperative levels (n = 5); ten patients (10.6%) had blood pressure readings of more than 40 mm Hg systolic or more than 20 mm Hg diastolic above preoperative levels. These elevations usually occurred in the first two postoperative hours and lasted approximately nine hours. Six patients required interventional therapy (intravenous nitroglycerin or sodium nitroprusside). No cardiac or central nervous system sequelae resulted, but two patients had postoperative hemorrhage and flap elevation by hematoma attributed to the hypertension. Carotid sinus denervation during radical neck dissection may be the cause of the reflex hypertension once general anesthesia-induced vasodilation has ended. Stripping of tumor from the carotid artery or placement of dermis grafts directly on the artery do not appear to influence postoperative development of hypertension.