Hypertension Post AAA Repair
OVERVIEW
- common
- potential life threatening -> myocardial ischaemia, anastomotic rupture, CVA
- requires urgent management and cause identification
CAUSES
- equipment/measurement error: check arterial line trace, transducer, NIBP
- wound pain: analgesia
- full bladder: make sure catheter draining
- inadequate sedation: sedate
- incomplete neuromuscular reversal: TOF assessment + sedation
- hypothermia/shivering: measure core temperature and warm
- hypoxia: treat cause and give O2
- hypercarbia: treat cause and increase ventilation
- withheld anti-hypertensives
- surgical problem: anastomotic occlusion, renal artery occlusion -> examine pulses and contact surgeon
MANAGEMENT
Resuscitation
A – assess for patency and position
B – give FiO2 1.0, check ABG
C – check pulses and BP manually, check accuracy of arterial line measurement
D – ensure patient adequately sedation and analgesia -> use propofol and fast acting opioid
Acid-base and Electrolytes
- review ABG to check metabolic status
Specific Therapy
- be aware that patient may be very sensitive to medications and become profoundly hypotensive
- esmolol: 10mg bolus
- GTN: 20-50mcg bolus -> infusion
- SNP infusion
Underlying cause
- find cause and treat appropriately
References and Links
- Wiesbauer F. Hypertension. Medmastery
LITFL
Critical Care
Compendium
Chris is an Intensivist and ECMO specialist at The Alfred ICU, where he is Deputy Director (Education). He is a Clinical Adjunct Associate Professor at Monash University, the Lead for the Clinician Educator Incubator programme, and a CICM First Part Examiner.
He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives. He was one of the founders of the FOAM movement (Free Open-Access Medical education) has been recognised for his contributions to education with awards from ANZICS, ANZAHPE, and ACEM.
His one great achievement is being the father of three amazing children.
On Bluesky, he is @precordialthump.bsky.social and on the site that Elon has screwed up, he is @precordialthump.
| INTENSIVE | RAGE | Resuscitology | SMACC