Consideraciones perioperatorias en pacientes con hipertensión: el día de su cirugía

Abstract

High blood pressure readings (170/110 mmHg) are common in patients undergoing surgery during the perioperative period, which can sometimes lead to interprofessional team decision-making that can result in surgery cancellation or postponement, altering the therapeutic process of patients. Therefore, it is relevant to discuss the current approach and recommendations for these patients during the perioperative period. Methods: A non-systematic search of the literature was conducted to evaluate the evidence of the impact on perioperative outcomes after the cancellation of elective surgery in patients with blood pressure measurements on the day of surgery of 170/110 mmHg. Results: Surgical cancellation or rescheduling in patients with high blood pressure measurements on the day of surgery, with evidence of adequate prior control, did not show an increase in the morbidity and mortality of patients in the perioperative period. On the contrary, delaying the surgical procedure seeking the optimization of arterial hypertension in the immediate perioperative period without evidence of end organ damage entails therapeutic delays and increased health costs. Conclusion: Surgical cancellation with the aim of optimizing high blood pressure readings in patients with previously controlled arterial hypertension and without evidence of end organ damage has not been shown to impact perioperative outcomes. Postponing procedures with the aim of achieving control of preanesthetic blood pressure without evidence of end organ damage is not recommended. An active approach of reducing blood pressure with pharmacological interventions should be considered to facilitate intraoperative hemodynamic control of the patient.