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What causes high blood pressure after surgery?


This article is co-written by Jonas DeMuro, MD. Dr. DeMuro is a certified pediatric surgeon, specialist in emergency surgery from New York. He graduated from Stony Brook University School of Medicine in 1996.

The number of sources used in this article is 17. You will find a list of them at the bottom of the page.

If you have had surgery recently, your doctor may advise you to try to lower your blood pressure. This can be done by making changes in diet and lifestyle. Before making any changes, be sure to consult your doctor. He will advise you on the best options.

All operations may have certain risks, even if they are normal procedures. One of these risks is a change in blood pressure.

People may experience high blood pressure after surgery for a number of reasons. Regardless of whether you develop this complication, it depends on the type of surgery you have, the type of anesthesia and the prescribed medications, and whether you have had problems with blood pressure before.

Understanding Blood Pressure With blood pressure

Blood pressure is measured by writing two numbers. The highest number is systolic pressure. It describes the pressure when your heart beats and pumps blood. The lower number is diastolic pressure. This number describes the pressure when your heart is resting between beats. For example, you will see numbers represented as 120/80 mmHg. (millimeters of mercury).

According to the American College of Cardiology (ACC) and the American Heart Association (AHA), these are the ranges for normal, high and high blood pressure:

  • less than 120 systolic and less than 80 diastolic Increased:
  • 120 to 129 systolic and less than 80 diastolic Tall:
  • 130 or higher systolic or diastolic 80 or more

What is the danger of an increase in blood pressure during surgery?

In rare cases, with hypertension, the pressure remains high even despite the effect of anesthesia. This phenomenon is dangerous and requires monitoring of the patient's condition during the operation.

High blood pressure during local anesthesia or general anesthesia can cause large blood loss due to high vascular tone.

There are a number of risks associated with the administration of potent anesthesia to hypertensive patients. These include:

  • cerebral hemorrhages during surgery,
  • heart rhythm disturbance in response to anesthesia,
  • heart failure
  • hypertensive crisis after the termination of anesthesia.

Adequate hypertension therapy before surgery can help prevent dangerous complications. Usually the operating doctor, knowing about the high pressure in the patient, gives a number of recommendations for some time before the operation. This minimizes the negative effects of anesthesia.

High blood pressure during surgery may cause bleeding

Hypotension and anesthesia

If with hypertension the danger lies in the fact that the pressure remains high both during the action of anesthesia and after surgery, then with hypotension the risks are caused by a sudden drop in blood pressure.

After anesthesia, low blood pressure drops even lower, especially with general anesthesia. During the operation, patients' vital signs are carefully monitored, since there is a risk of pressure drop to critical values.

During the operation, the appearance of negative body reactions to the effect of anesthesia is possible. For hypotonics, this is dangerous with acute hypoxia of the brain and sudden cardiac arrest.

Help hypertensive after anesthesia

Having figured out that the pressure can indeed increase after anesthesia, you should first consult with the anesthetist and the operating doctor about methods of reducing pressure after the termination of the action of anesthesia.

Hypertensive patients are usually given an injection of magnesia to lower it in the hospital. The clinic staff carefully monitors the fluctuations in the patient’s blood pressure both at the time of surgery and after the termination of the anesthesia.

If magnesia is ineffective, more potent drugs can be used. In addition to drugs, a patient prone to high blood pressure is shown bed rest, regardless of the type of operation, and rest. To speed up recovery after anesthesia, a balanced diet is needed.

Before the operation, hypertonic should inform the doctor about all allergic reactions to the drugs. It is imperative to inform the doctor about antihypertensive drugs that the patient takes continuously.

Despite the discomfort during the pressure jump, the patient has nothing to worry about, since the normalization of blood pressure after the operation is carried out by qualified specialists.

Hypertension is one of the most common concomitant diseases in people in need of surgical treatment. Without going into consideration of the pathogenesis of this condition, we briefly discuss the dangerous consequences that hypertension can cause during anesthesia and surgery. There are several of them: 1) increased bleeding, which increases operational blood loss, 2) high sensitivity of the cardiovascular system to various effects, including pharmacological, 3) the possibility of hemorrhage in the brain before, during and after surgery, 4) a tendency to develop acute or progressive heart failure, especially if coronary insufficiency is accompanied by hypertension.

High blood pressure places two demands on the anesthetist: a) not to use substances and effects that enhance hypertension, b) to protect the cardiovascular system from reflex effects that increase blood pressure. The high activity of vascular reflexes explains the ease with which severe hypertensive crises occur. An acute rise in pressure that began during anesthesia and surgery can cause a stroke, acute heart weakness. Patients with so-called hypertensive encephalopathy and brain disorders in the past are especially prone to strokes.

Of the special therapeutic effects for the expansion of the vessels of the brain, aminophylline (synthillin) is used, the effectiveness of which, however, is disputed. Lassen (Lassen, 1959) provides evidence that aminophylline causes a distinct decrease in cerebral blood flow in humans by about 25%. Therefore, the main way to prevent cerebral spasm and stroke, obviously, should be to reduce vascular tone in general, and the exclusion of hypertensive crises.

Finally, hypertensive crises are dangerous in one more respect. A sharp, usually sudden increase in vascular resistance can cause heart overload and acute left ventricular failure. Thus, the fight against high blood pressure in general, and the increase in hypertension during the operation in particular, is at the center of the efforts of the anesthesiologist. In the preoperative period with the participation of a therapist, measures are taken to reduce blood pressure and eliminate crises. For the same purpose, during anesthesia and surgery, gangliolytics are used that allow the ability to control the level of blood pressure. The dosage of these substances is strictly individual and, in any case, obviously less than that which is considered optimal for patients with normal pressure. So, the initial dose of hexonium is usually 20-25 mg, pentamine 30-50 mg. Arfonad is administered dropwise in the form of a 0.1% solution at a rate of 60-100 drops at the beginning and 10-15 drops in the future, depending on the chosen level of blood pressure. Sometimes the initial doses of hexonium and pentamine are insufficient and they have to be increased, guided by the level of blood pressure.

This path so far seems to be the most real and effective of all available. But we will not forget about the shadow sides of this direction. In hypertension, cell metabolism is adapted to high blood pressure and any significant decrease in it quickly leads to symptoms of oxygen starvation. Nevertheless, the ganglion block is beneficial in connection with the protection of the cardiovascular system from excessive reflex influences. Only he can completely and with the least risk prevent hypertensive crises. This suggests the following logical conclusion: the decrease in blood pressure should be moderate (no more than 30-40 mm from the initial high level), and the transmission interruption in the ganglia should be as complete as possible. If you think about the motives given above, you can’t help but think of the advisability of a ganglion block without hypotension (more precisely, with moderate hypotension) during interventions in these patients.

Purely anesthetic issues . As in the previous chapters, we will now try to clarify the general requirements for anesthesia for patients with pathology of the cardiovascular system.

1. The chosen method of anesthesia should provide an enhanced supply of oxygen to the blood and adequate removal of carbon dioxide at all stages of the intervention. Good management of anesthesia is essential.

2. For sedation and anesthesia, only those agents can be used that do not cause sharp fluctuations in blood pressure, do not inhibit the myocardium and do not increase its irritability.

3. All factors that create an increased load on the circulatory system (mental stress before surgery, agitation during the induction period, excessive intravenous infusions, etc.) are extremely dangerous and should be excluded.

4. By their actions, the anesthesiologist must maintain a stable blood composition and volume (timely and full compensation for blood loss, accounting and compensation for pH shifts, and electrolyte blood composition), provide myocardial nutrition and protect it from the harmful effects of the reflex order.

From the point of view of the choice of drug, means of sedation and additional pharmacological effects, the possibilities of the anesthesiologist are limited, while the tasks facing him are very diverse. Of the large arsenal of funds, only those that do not inhibit the myocardium, do not cause hypotension, and do not delay the awakening of the patient are suitable. For this reason, it is necessary to significantly reduce the dose of thiopental and abandon the technique of anesthesia, which involves the re-introduction of this substance. At the same time, thiopental remains the drug of choice for induction anesthesia here. Not so much the drug itself is dangerous as its inept use. Slow administration of it in a minimal dose (0.2-0.25 g in a 2% solution) against the background of an excess oxygen supply through a mask or catheter avoids hypotension, respiratory depression and hypoxia. Three agents - nitrous oxide, ether and cyclopropane most of all meet the requirements as a means of maintaining anesthesia. Shallow intubation ethereal anesthesia (stage I stage III) or inhalation of nitrous oxide after mild sedation, conducted against the background of complete muscle relaxation, ganglion block without hypotension with controlled breathing are the most accessible and quite safe in the category of patients. Despite the continued widespread dominance of the ether, against which there are no strong objections in this group of patients, one should remember about hyperglycemia, acidotic changes and possible impaired liver function. For these reasons, as well as in view of the long-term post-anesthetic depression of nitrous oxide, preference is given. Of course, nitrous oxide anesthesia should not be hypoxic. In the latter case, an unstable compensation of the functions of the cardiovascular system becomes explicit, and explicit in threatening.

The optimal ratio of nitrous oxide and oxygen in the narcotic mixture for anesthesia of patients with heart disease should be considered 1: 1. This proportion of gases can be easily maintained if, after intubation for 3-5 minutes, the lungs are hyperventilated with high concentrations of ether, and after the restoration of spontaneous breathing (when the action of dithylin is completed), switch to a semi-open circuit with the patient supplying I l of oxygen and 1 l of laughing gas B under the conditions of the ganglion block in the quiet stages of the operation, we manage to maintain anesthesia with inhalations of 1.5 liters of oxygen and 1 liter of nitrous oxide without curation. A good addition to nitrous oxide is the intravenous administration of local anesthetics or viadryl, which we have already discussed. With extensive laparotomy and thoracotomies, our sympathies are always on the side of nitrous oxide, especially when it comes to risky operations in the elderly and patients who, in addition to concomitant heart diseases, have insufficient liver and kidney function. Urgent interventions favorably proceed under gas anesthesia. Interventions regarding the “acute abdomen” in patients with peritonitis and intoxication due to intestinal obstruction, which will be discussed later.

With the introduction of anesthesia, cyclopropane is practically not limited to the supply of oxygen (75-80 vol,% O 2). However, its ability to increase blood pressure and myocardial excitability does not allow recommending this drug for patients with cardiovascular pathology. However, there are other opinions on this score. Cyclopropane in combination with nitrous oxide and oxygen is used (according to the Schein-Ashman method) with good results.

There are currently no medical procedures that have no complications. Despite the fact that modern anesthesiology uses selective and safe drugs, and the anesthesia technique is improved every year, there are complications after anesthesia.

There may be unpleasant consequences after anesthesia.

When preparing for a planned operation or when faced with its inevitability suddenly, everyone feels anxiety not only about the surgical intervention itself, but even more because of the side effects of general anesthesia.

Adverse events of this procedure can be divided into two groups (by the time they occur):

  1. Occur during the procedure.
  2. Develop after a different time after the completion of the operation.

During surgery:

  1. From the respiratory system: sudden respiratory arrest, bronchospasm, laryngospasm, pathological restoration of spontaneous breathing, pulmonary edema, respiratory arrest after its recovery.
  2. From the cardiovascular system: increased heart rate (tachycardia), slowdown (bradycardia), and heart rhythm disturbance (arrhythmia). Drop in blood pressure.
  3. From the nervous system: convulsions, hyperthermia (fever), hypothermia (fever), vomiting, tremors (tremors), hypoxia and cerebral edema.

During the operation, the patient is constantly monitored to avoid complications

All complications during the procedure are controlled by the anesthetist and have strict algorithms for medical actions aimed at stopping them. The doctor has drugs at hand to treat possible complications.

Many patients describe visions during anesthesia - hallucinations. Hallucinations make patients worry about their own mental health. Do not worry, because some narcotic drugs used for general anesthesia cause hallucinations. Hallucinations during anesthesia occur in mentally healthy people and do not recur after the completion of the drug.

After the operation is completed

After general anesthesia, a number of complications develop, some of them require long-term treatment:

  1. From the respiratory system .

Often manifested after anesthesia: laryngitis, pharyngitis, bronchitis. These are the consequences of the mechanical effects of the equipment used and the inhalation of concentrated gaseous narcotic drugs. Manifested by cough, hoarseness, pain when swallowing. They usually pass within a week without consequences for the patient.

Pneumonia. Complications are possible if gastric contents enter the respiratory tract (aspiration) during vomiting. Treatment will require additional hospital stay after surgery and the use of antibacterial drugs.

Central hyperthermia - An increase in body temperature not related to infection. This phenomenon may be a consequence of the reaction of the body to the introduction of drugs that reduce the secretion of sweat glands, which are introduced to the patient before surgery. The patient's condition is normalized within one to two days after the termination of their action.

Elevated body temperature is a frequent consequence of anesthesia

Headaches after anesthesia are a consequence of side effects of drugs for central anesthesia, as well as complications during anesthesia (prolonged hypoxia and cerebral edema). Their duration can reach several months, pass independently.

Encephalopathy (impaired cognitive function of the brain). Есть две причины для ее развития: является последствием токсического действия наркотических препаратов и длительного гипоксического состояния головного мозга при осложнении анестезии.Despite the widespread opinion about the frequency of encephalopathy, neurologists claim that it develops rarely and only in people with risk factors (background brain diseases, senile age, previous chronic effects of alcohol and / or drugs). Encephalopathy is a reversible phenomenon, but requires a long recovery period.

To speed up the process of restoration of brain function, doctors suggest that they carry out preventive measures before the planned procedure. In order to prevent encephalopathy, vascular preparations are prescribed. Their selection is carried out by the doctor, taking into account the characteristics of the patient and the planned operation. It is not necessary to carry out independent prevention of encephalopathy, since many drugs can change blood coagulation, as well as affect the susceptibility to drugs for anesthesia.

Peripheral neuropathy of the limbs. It develops as a consequence of a patient's prolonged stay in a forced position. It appears after anesthesia by paresis of the muscles of the extremities. It takes a long time, requires physiotherapy and physiotherapy.

Spinal and epidural anesthesia

Spinal and epidural analgesia replace anesthesia. Such types of anesthesia are completely devoid of side effects of anesthesia, but their implementation has its own complications and consequences:

Often, after anesthesia, the patient has a headache

  1. Headache and dizziness. A frequent side effect, manifested in the first days after surgery, ends with recovery. Rarely, headaches are persistent and last a long time after surgery. But as a rule, such a psychosomatic state, that is, due to the suspiciousness of the patient.
  2. Paresthesia (tingling, crawling sensation on the skin of the lower extremities) and loss of sensitivity in the areas of the skin of the legs and body. It does not require treatment and passes on its own within a few days.
  3. Constipation Often occur during the first three days after surgery as a consequence of anesthesia of nerve fibers innervating the intestine. After restoration of nerve sensitivity, the function is restored. In the early days, taking mild laxatives and folk remedies helps.
  4. Neuralgia of the spinal nerves. The consequence of nerve injury during puncture. A characteristic manifestation is pain in the innervated area, lasting several months. Physiotherapy exercises and physiotherapy help accelerate the process of its restoration.
  5. Hematoma (hemorrhage) at the puncture site . Accompanied by pain in the damaged area, headaches and dizziness. With resorption of the hematoma, there are increases in body temperature. As a rule, the condition ends in recovery.

Stem and infiltration anesthesia

  1. Hematomas (hemorrhages). They arise as a result of damage to small vessels in the anesthesia zone. Manifested by bruising and soreness. Pass on their own within a week.
  2. Neuritis (inflammation of the nerve). Pain along the nerve fiber, impaired sensitivity, paresthesia. Consult a neurologist.
  3. Abscesses (suppuration). Their occurrence requires additional antibiotic treatment, most likely in a hospital setting.

A complication of any type of anesthesia, from superficial to anesthesia, may be the development of allergic reactions. Allergies are of varying severity, from hyperemia and rash, to the development of anaphylactic shock. These types of side effects can happen on any drug and food. They cannot be predicted if the patient has not previously used the medicine.

Means for anesthesia slightly reduce pressure, reduce the pulse and respiratory rate. But this is provided that under anesthesia the pressure indicators were within normal limits. Low or high pressure in combination with anesthesia can cause serious complications, so specialists before the operation seek to resolve all the indicators.

General information

General anesthesia is a temporary inhibition of the functions of the central nervous system, which is accompanied by a turn-off of consciousness, depression of sensitivity, muscle relaxation, suppression of reflexes and analgesia for surgical intervention. General anesthesia is performed by suppressing the synaptic connection between neurons. There are 4 consecutive stages of general anesthesia, each of which is characterized by different indicators:

Indicate your pressure

  • HELL - blood pressure
  • Heart rate - heart rate,
  • BH - respiratory rate.

Why is anesthesia dangerous?

In case of overdose, if anesthesia touches the respiratory and vascular-motor centers of the medulla oblongata, the agonal stage begins. Breathing stops and death comes. In addition to overdose, there are other complications:

  • Hypoxic syndrome, which may be due to airway obstruction by vomit, laryngospasm and bronchospasm.
  • Hypertensive crisis, hemorrhagic stroke, if hypertension was not resolved before surgery. Hypotonic crisis may occur due to blood loss or if anesthesia is administered under reduced pressure. Rarely, there may be myocardial infarction, pulmonary edema, and pulmonary thrombosis.
  • Anaphylactic shock. Functional adrenal insufficiency.
  • After anesthesia, jumps in blood pressure may occur.

If you have had surgery recently, your doctor may advise you to try to lower your blood pressure. This can be done by making changes in diet and lifestyle. Before making any changes, be sure to consult your doctor. He will advise you on the best options.

Changes in diet with low physical activity

Use less sodium. Sodium is found in salt, so limit its use. Salt gives food a taste. Some people accustomed to salty foods can consume up to 3.5 grams of sodium (in salt) daily. If you have high blood pressure after surgery and you need to lower it, your doctor will recommend that you limit the amount of salt in your diet. In this case, not more than 2.3 grams of sodium should be consumed daily. Take the following steps:

  • Be careful about light snacks you eat. Instead of snacks such as chips, salted pretzels or nuts, go for apples, bananas, carrots or bell peppers.
  • Choose canned foods with low or no salt content, paying attention to the composition indicated on the package.
  • Use a lot less salt when cooking, or don't add it at all. Instead of salt, use other seasonings such as cinnamon, paprika, parsley or marjoram. Hide the salt shaker so as not to add salt to the dishes.

Improve your health with whole grain products. They contain more nutrients and dietary fiber than white flour, and they can be more easily saturated. Try to get the bulk of calories from whole grains and other foods that contain complex carbohydrates. Eat six to eight servings a day. One serving may, for example, consist of half a glass of rice or a slice of bread. Increase your intake of whole grains in the following ways:

  • Eat oatmeal or cereal for breakfast. To sweeten the porridge and give it a taste, add fresh fruit or raisins to it.
  • Study the composition of the bread you buy, making sure that it is made from whole grains.
  • Instead of white flour, switch to pasta and whole-grain flour.

Eat more vegetables and fruits. Four to five servings of fruits and vegetables are recommended per day. The size of one serving is about half a glass. Vegetables and fruits contain trace elements such as potassium and magnesium, which help regulate blood pressure. You can increase your intake of fruits and vegetables as follows:

  • Start your meal with a salad. Eating salad first, you muffle the feeling of hunger. Do not leave the salad for the last time - if you are full, you are unlikely to want it. Variety of salads by adding various vegetables and fruits. Do not add a lot of salted nuts, cheese or dressing to salads, as they contain a lot of salt. Instead of dressing, use almost no sodium oil and vinegar.
  • For a quick bite, keep ready-to-eat fruits and vegetables handy. Going to work or school, grab peeled carrots, slices of sweet pepper, or an apple with you.

Limit fat intake. A high-fat diet can lead to clogged arteries and high blood pressure. There are many attractive ways to reduce fat intake, while receiving all the nutrients needed to recover from surgery.

Limit your sugar intake. Refined sugar contributes to overeating because it does not contain the nutrients the body needs to feel full. Try to eat no more than five sweets weekly.

  • Although artificial sugar substitutes like Splenda (sucralose), Nutrisvit, and Equal (aspartame) can quench your cravings for sweets, try replacing sweets with healthier snacks such as fruits and vegetables.

Maintaining a healthy lifestyle after surgery

Stop smoking. Smoking and / or chewing tobacco narrows blood vessels and reduces their elasticity, leading to an increase in blood pressure. If you live with a smoker, ask him / her not to smoke in your presence so that you do not breathe tobacco smoke. This is especially important during the recovery period after surgery. If you smoke yourself, try to give up this bad habit. To do this, proceed as follows:

Do not drink alcohol. If you have recently undergone a surgical operation, then most likely you are taking medications that contribute to an early recovery. Alcohol interacts with many medicines.

  • In addition, your doctor may advise you to lose weight, and alcoholic beverages contain a large number of calories, which will complicate your task.
  • If you find it difficult to quit drinking alcohol, consult your doctor who can prescribe the appropriate treatment for you and recommend where you can go for support.

Try to reduce stress. Recovery from surgery is not easy both from a physical and psychological point of view. Try the following popular relaxation methods that you can practice even with limited mobility:

  • Music or art therapy
  • Visualization (presentation of calming pictures)
  • Progressive tension and relaxation of certain muscle groups

If your doctor permits, exercise. This is a great way to reduce stress and lose weight. However, in the process of recovery after surgery, it is important to observe the measure and not overload your body.

  • Daily walks are quite safe after many types of operations, so consult your doctor about them.
  • Talk to your doctor and physiotherapist about a safe exercise program. Continue to visit your doctor and physiotherapist regularly so they can check your condition and make sure that physical exercise is good for you.

Cardiac surgery and other large blood vessel surgery are often associated with a risk of developing blood pressure during surgery. Also often for many people undergoing these procedures, there is already high blood pressure. If your blood pressure is poorly controlled before entering surgery, there is a good chance that you will experience complications during or after surgery.

Inadequately controlled high blood pressure means that your numbers are in a wide range and your blood pressure is not effectively treated. This may be due to the fact that the doctors did not make a diagnosis before the operation, your current treatment plan does not work, or maybe you did not take the medicine regularly.

Withdrawal of medicines. Withdrawal of medication

If your body has been used for a treatment that lowers blood pressure, it is possible that you may suddenly leave them. With certain medications, this means that you may have a sudden surge in blood pressure.

It is important to tell your surgical team if they do not yet know which blood pressure medications you are taking and which doses you have missed. Often, some medications may even be taken in the morning after surgery, so you don’t need to miss a dose. It is best to confirm this with your surgeon or anesthetist.

Pain level blood level

Some prescription or over-the-counter (OTC) medicines may increase your blood pressure. One of the known side effects of nonsteroidal anti-inflammatory drugs (NSAIDs) may be a slight increase in blood pressure in people who already have high blood pressure. If you already have high blood pressure before surgery, talk with your doctor about pain management options. They may recommend different medicines or you have alternative medicines, so you do not take them for a long time.

Here are a few examples of common NSAIDs, both prescription and over-the-counter, which can increase blood pressure:

ibuprofen (Advil, Motrin)

  • meloxicam (Mobic)
  • naproxen (Aleve, Narosin)
  • Naproxen Sodium (Anaprox)
  • piroxicam (Feldene)
  • Prospects. What is the prospect?