Cardiovascular per and postoperative complications in the hypertensive patient

Hugues Martial NYA SAH (mhugues2013@yahoo.fr)
Surgery and specialities, Yaounde I
June, 2014
 
Medical Doctor and researcher from the Faculty of Medicine and Biomedical Sciences of Yaounde I university, Cameroon
 

Abstract

Hypertension is a worldwide public health problem. According to several studies, the prevalence of hypertension in Cameroon varies around 25%. Hypertension is the most frequent cardiovascular risk factor. In France, it is the most frequent pathology in patients to undergo surgery. In Cameroon, a study carried out by Binam and collaborators in 1998 showed a prevalence of about 12.6%. Peroperatory hemodynamic instability is common in the hypertensive patient, and is responsible for the risks these patients are subject to during surgical interventions.The aim of this study was to evaluate the risk of occurrence of cardiovascular complication during and after surgery in the hypertensive patient.
We carried out a prospective and descriptive study involving hypertensive patients awaiting general surgery in 3 hospitals in the town of Yaounde over a three month period. Sampling was consecutive and nonrandomised. Data from patients’ files, anesthesia forms and theatre room registers was collected on a preconceived form.
A total of 62 patients were included in the study. The prevalence was 12.5%. The mean age was 59 ± 11.45 years. The most represented branches of surgery were orthopaedic and gynaecological surgery, each representing 20.9% of all interventions. Obesity was the most frequent cardiovascular risk factor (30.6%). Other risk factors encountered included diabetes (21%) and overweight (33%). End organ damage, when present, was predominantly left ventricular hypertrophy in 22.58% of cases. From the study population, 31.6% of patients had a Lee score of 1 and 2, while 25.8% of patients were evaluated as ASA 3 and 4. Only 12.9% of patients had no perioperatory risk factors. The main peroperatory complication was hypotension, observed in 46.8% of cases. Hypertensive peaks were observed in 30.6% of cases, while 32.3% developed tachycardia. After surgery, 19.4% of patients developed a hypertensive surge, and 4 patients died. Throughout our study no myocardial infarctions or myocardial ischemic lesions were observed. Pre-operatory blood pressure instability and general anaesthesia were found to be factors favouring hemodynamic instability.
At the end of the study, we can conclude that the prevalence of hypertension in surgical settings is high. The hemodynamic instability during surgery was the main complication associated to hypertension. The risk factors for this complication were blood pressure instability prior to surgery and general anaesthesia.


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