Management of orthopedic patients with hypertension in the perioperative period (literature review)

Inga Fedotova, Iryna Korzh, Mykola Lyzogub, Oleksandr Barkov, Valentyn Piontkovsky


Despite significant advances of modern therapies, problem of combination and the simultaneous natural history of vari­ous diseases of bones and joints in patients with cardiovascular disorders, remains extremely relevant. Performance of surgical intervention requires anesthesia and hypertension is a known risk factor of adverse outcome in 35 % of patients, it is clear that poorly controlled hypertension remains one of the most com­mon reason for the postponing a scheduled surgeries. Objective: to determine optimal perioperative measures to minimize car­diovascular complications, basing on the analysis of scientific and medical literature. The paper discussing in details the use in the perioperative period different groups of hypotensive drugs (diuretics, inhibitors angiotensin-converting enzyme, sartanas, calcium channel blockers, β-blockers). It is shown that there is sufficient evidence as to the overall cardioprotective effect of general inhalation or intravenous anesthesia. Also ongoing debate about the benefits of neuroaksial methods before general anesthesia and in the ESA/ESC-2014 guidelines provided a rea­sonable level of evidence (IIb) for advantages of spinal anes­thesia and analgesia in reducing the frequency of serious post­operative complications. Authors for improving the safety and effectiveness of surgery in elderly patients with comorbidities emphasize such basic areas for preoperative evaluation methods in patients as risk prediction, identifying factors that increase the risk of surgery and anesthesia, studying hemodynamic status and specifics of anesthesia, study, creation and implementation of best preoperative preparation options, sedation, intraopera­tive pharmacologically protection and postoperative intensive care, depending on the patient, primary and concomitant pa­thology, specifics of hypertension and previous drug therapy.


surgical intervention; hypertension; antihypertensive drugs; perioperative period


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