Perioperative blood pressure control in hypertensive and normotensive patients undergoing off-pump coronary artery bypass grafting: prospective study of current anesthesia practice.
OBJECTIVE
To analyze blood pressure changes during intra- and immediate postoperative period in patients undergoing off-pump coronary artery bypass grafting.


METHODS
The study included 355 consecutive patients undergoing off-pump coronary artery bypass grafting between January 5, 2004 and December 30, 2005. Out of these patients, 325 were allocated into groups with preoperative history of hypertension (n=115) and without preoperative history of hypertension (n=210). Systolic, diastolic, and mean arterial blood pressure was measured at the following four time points: on the day before surgery, before anesthesia induction, after the last graft, and on entry to intensive care unit.


RESULTS
Mean arterial pressure was significantly higher in patients with a history of hypertension on the day before surgery (97 vs 92 mm Hg, P=0.003, Mann-Whitney test) and before anesthesia induction (107 vs 98 mm Hg; P=0.003). It was higher at all measuring points (after the last graft, 79 vs 78 mm Hg; and on entry to intensive care unit, 88 vs 86 mm Hg), but this difference was neither statistically nor clinically significant. The study showed that mean arterial pressure followed similar dynamics over time in both patient groups (P<0.001 both), with no significant time-dependent between-group differences.


CONCLUSIONS
Current anesthesia techniques that include deep opioid analgesia in combination with vasodilators provide a satisfactory control of intraoperative hypertension. Management of blood pressure changes during intra- and immediate postoperative period in off-pump coronary artery bypass grafting patients with preoperative hypertension was no more difficult than in patients without preoperative hypertension.
Barisin
Stjepan
S
Department of Anesthesiology, Resuscitation, and Intensive Care, Dubrava University Hospital, Zagreb, Croatia. stjepan.barisin@zg.htnet.hr
Sakić
Kata
K
Goranović
Tatjana
T
Barisin
Ana
A
Sonicki
Zdenko
Z
D000768:Anesthesia, General; D001794:Blood Pressure; D047549:Coronary Artery Bypass, Off-Pump; D005260:Female; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D019990:Perioperative Care