Anaesthesia for Emergency Surgical Patients with Co-existing Hypertension: A Clinical Challenge

Abstract

Background: Hypertension is a medical condition that may co-exist with any surgical disease. Hypertension is defined as a sustained increase in blood pressure (BP) >140/90 mm Hg in a patient not taking antihypertensive drugs. It has been estimated that the overall prevalence of hypertension in Nigeria is 28.9%. Hypertension becomes a challenge to the anaesthetist when the hypertensive patient presents for an emergency operation.
Methodology: This study was a retrospective audit review of anaesthetic charts, case notes and operation records of adult patients that were operated at the accident and emergency (A&E) theatre of a tertiary hospital in the North-West zone of Nigeria over a 6 months period during 2014. Patient's age, sex, type of surgery and anaesthetic technique were collated. Data obtained were expressed as numbers and percentages.
Results: A total of 182 adult patients had emergency surgery. Females were 95(52.2%). General surgery had the highest number (38.5%) of patients followed by Obstetrics with 32.4%. Gynaecological surgery had the lowest number of patients (5.5%). Forty (22%) of patients operated during the period had high blood pressure (>140/90mmHg). Twelve of the hypertensive patients (30%) had urological operations followed by general surgical procedures with 11 patients (27.5%). Four patients (10%) had gynaecological surgery. General anaesthesia (GA) was administered in 80% of the cases while the remaining 8 patients had spinal anaesthesia.
Conclusion: Twenty two percent of study patients were hypertensive and most of them had urological or general surgical procedures. GA was the preferred technique of anaesthesia during the review period.