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Anesthetic Management of the Hypertensive Patient: Part I
Russell Yancey DDS
Article Category: Research Article
Volume/Issue: Volume 65: Issue 2
Online Publication Date: Jan 01, 2018
DOI: 10.2344/anpr-65-02-12
Page Range: 131 – 138

Blood pressure typically fluctuates throughout the day, but hypertension, or high blood pressure, can cause undue stress on the patient's heart, vasculature, and other organs, leading to a variety of health problems. Those health problems include heart disease and stroke, which are the leading causes of death in the United States. 1 Almost half of Americans are identified as having high blood pressure according to the recent classification changes of high blood pressure in 2017 by the American Heart Association and the American College of

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Anesthetic Management of the Hypertensive Patient: Part II
Russell Yancey DDS
Article Category: Research Article
Volume/Issue: Volume 65: Issue 3
Online Publication Date: Jan 01, 2018
DOI: 10.2344/anpr-65-03-17
Page Range: 206 – 213

Part I of this series provided an overview of hypertension and the physiology of blood pressure regulation. In addition, drugs affecting predominantly renal control of hypertension were discussed. In part II, the remaining major antihypertensive medications will be reviewed as well as anesthetic implications of managing patients with hypertension. CALCIUM CHANNEL BLOCKERS The currently available calcium channel blockers (CCBs) inhibit the opening of L-type voltage-gated calcium channels, and when inward flux of

Perioperative Management of a Patient With Idiopathic Pulmonary Hypertension and a History of Syncope: A Case Report
Aiji Sato (Boku) DDS, PhD;,
 MinHye So MD, PhD;,
 Kazuma Fujikake MD, PhD;,
 Motoshi Tanaka MD;,
 Yuji Kamimura MD, PhD;,
 Haruko Ota MD, PhD;,
 Tomomi Mizutani DDS,
 Kenichiro Ishibashi DDS, PhD;,
 Yasuyuki Shibuya DDS, PhD;, and
 Kazuya Sobue MD, PhD
Article Category: Case Report
Volume/Issue: Volume 71: Issue 1
Online Publication Date: May 03, 2024
DOI: 10.2344/anpr-70-03-08
Page Range: 29 – 33

Pulmonary hypertension (PH) is a condition wherein the pulmonary artery pressure (PAP) is abnormally high (normal: mean PAP, 25 mm Hg). Key points in anesthetic management of patients with PH include maintaining systemic blood pressure (BP), avoiding hypoxemia and hypercapnia, and providing adequate analgesia. 1 An individualized preoperative risk assessment and treatment optimization along with advanced perioperative planning may improve anesthetic management outcomes for patients with PH. 2 We present the case of a patient with idiopathic pulmonary

Cardiovascular Collapse Associated With Irreversible Cardiomyopathy, Chronic Renal Failure, and Hypertension During Routine Dental Care
Sean Thoms DMD, MS,
 Matthew Cooke DDS, MD, MPH, and
 James Crawford DMD
Article Category: Case Report
Volume/Issue: Volume 63: Issue 1
Online Publication Date: Jan 01, 2016
DOI: 10.2344/0003-3006-63.1.34
Page Range: 34 – 41

. CASE DESCRIPTION A 65-year old, 155-cm (5 foot, 1 inch), African American female weighing 70 kg presented to the University of Pittsburgh, School of Dental Medicine, for a single amalgam filling in the undergraduate dental clinic. The patient had a significant health history consisting of hypertension, angina, poorly controlled congestive heart failure, asthma, epilepsy, and end-stage renal disease for which she was hemodialyzed via a fistula in her left forearm 4 times per week. Other medical history included gastroesophageal reflux disease

Figure 3.; Hypertension algorithm. Episodes of hypertension rarely require treatment. Asymptomatic episodes will generally correct after addressing possible causes. If pressure remains elevated, referral to the primary care physician should be considered. When accompanied by symptoms, emergency medical service transport should be arranged and nitroglycerin or labetalol may be considered.
Daniel E Becker and
 Daniel A Haas
Figure 3.
Figure 3.

Hypertension algorithm. Episodes of hypertension rarely require treatment. Asymptomatic episodes will generally correct after addressing possible causes. If pressure remains elevated, referral to the primary care physician should be considered. When accompanied by symptoms, emergency medical service transport should be arranged and nitroglycerin or labetalol may be considered.

; The renin angiotensin aldosterone system is a relatively slow, hormonal mechanism whereby there is a long-term blood pressure regulation.
Russell Yancey

The renin angiotensin aldosterone system is a relatively slow, hormonal mechanism whereby there is a long-term blood pressure regulation.

Figure 1; Influences provided by vasodilators. Cardiac output is the principal determinant of systolic pressure while arterial resistance determines diastolic pressure. Venous dilation reduces venous return and subsequent cardiac output, while arterial dilation reduces arterial resistance. This accounts for the value of vasodilation in managing hypertension. In contrast, benefits for managing coronary artery disease (CAD) and congestive heart failure (CHF) relate to reducing stresses on the heart—preload and afterload. Preload (venous return) is a stress factor during diastole, and afterload (arterial resistance) stresses the heart during systole.
Daniel E. Becker
Figure 1
Figure 1

Influences provided by vasodilators. Cardiac output is the principal determinant of systolic pressure while arterial resistance determines diastolic pressure. Venous dilation reduces venous return and subsequent cardiac output, while arterial dilation reduces arterial resistance. This accounts for the value of vasodilation in managing hypertension. In contrast, benefits for managing coronary artery disease (CAD) and congestive heart failure (CHF) relate to reducing stresses on the heart—preload and afterload. Preload (venous return) is a stress factor during diastole, and afterload (arterial resistance) stresses the heart during systole.

Figure 2.; The blockade effect of propranolol (Pro) on hemodynamic changes by drug interaction between adrenaline (AD) and chlorpromazine (Ch) on mean blood pressure (MBP) (a) and pulse rate (PR) (b) (Ch + saline: n = 4; Ch + Pro + AD: n = 3). AD induced modest hypertension, but did not significantly influence pulse rate change in Pro + Ch–pretreated rats. P values are for between-agent comparisons (vs the value for Ch + saline) at specified time intervals by using 2-way analysis of variance with Bonferroni's post hoc test. Data represent means ± SD.
Hitoshi Higuchi,
 Akiko Yabuki,
 Minako Ishii-Maruhama,
 Yumiko Tomoyasu,
 Shigeru Maeda, and
 Takuya Miyawaki
Figure 2.
Figure 2.

The blockade effect of propranolol (Pro) on hemodynamic changes by drug interaction between adrenaline (AD) and chlorpromazine (Ch) on mean blood pressure (MBP) (a) and pulse rate (PR) (b) (Ch + saline: n = 4; Ch + Pro + AD: n = 3). AD induced modest hypertension, but did not significantly influence pulse rate change in Pro + Ch–pretreated rats. P values are for between-agent comparisons (vs the value for Ch + saline) at specified time intervals by using 2-way analysis of variance with Bonferroni's post hoc test. Data represent means ± SD.

Acute Angle-Closure Glaucoma After General Anesthesia for Bone Grafting
Yukie Nitta DDS, PhD,
 Nobuhito Kamekura DDS, PhD,
 Shigeru Takuma DDS, PhD, and
 Toshiaki Fujisawa DDS, PhD
Article Category: Other
Volume/Issue: Volume 61: Issue 4
Online Publication Date: Jan 01, 2014
DOI: 10.2344/0003-3006-61.4.162
Page Range: 162 – 164

had anatomical abnormalities as a risk factor for postoperative AACG. Many factors are associated with intraocular pressure during anesthesia. 2 , 4 Most anesthetic drugs are associated with intraocular hypotension. Endotracheal intubation, extubation, bucking, hypoxia, acute hypertension, prone position, and excessive transfusion are the factors associated with intraocular hypertension. 3 In this case, endotracheal intubation and extubation were smooth and no significant elevation of blood pressure was evident. Bucking, hypoxia, and acute hypertension did

Alpha-2 Adrenergic Receptor Agonists: A Review of Current Clinical Applications
Joseph A. Giovannitti Jr DMD,
 Sean M. Thoms DMD, MS, and
 James J. Crawford DMD
Article Category: Other
Volume/Issue: Volume 62: Issue 1
Online Publication Date: Jan 01, 2015
DOI: 10.2344/0003-3006-62.1.31
Page Range: 31 – 38

. Table 2. Summary of α-2 Receptor Agonists and Pharmacological Properties* CLONIDINE Clonidine is the prototypical α-2 agonist, with an affinity predilection of 200 : 1 for α-2 versus α-1 receptors, respectively. It was first used as a nasal decongestant, but is now most frequently used in the management of hypertension because it was discovered coincidentally to lower systemic blood pressure through central brainstem adrenergic stimulation. Clonidine is rapidly and almost completely absorbed