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PERIOPERATIVE ANAESTHESIA MANAGEMENT AND OUTCOMES IN PATIENTS WITH PRE INDUCTION HYPERTENSION FOR ELECTIVE CANCER SURGERY

Objective: Uncontrolled hypertension is a known risk factor for perioperative complications though postponement of surgery is recommended only for blood pressure (BP) more than 180 /110 mm Hg. These recommendations come from developed countries where on table hypertension in a previously normotensive individual may be the effect of anxiety. There is not much literature on the impact of preoperative BP below these values on perioperative complications particularly in populations with inadequate primary health care where the hypertension may indicate inadequate treatment thereby increasing perioperative risk. Also in cancer surgery, due to extensive dissection the impact of hypertension on bleeding complications may be higher. The aim of this audit was to understand the impact of high preinduction blood pressure on the perioperative management and outcomes in intermediate risk cancer surgeries. Design and method: This was a single centre prospective observational study conducted in a tertiary care cancer hospital over 6 months. All adult patients undergoing elective cancer surgery who had a preinduction blood pressure higher than 140 /90 mm Hg and 150 /90 in patients < 60 years of age and > 60 years of age respectively were studied. Perioperative complications in these patients were compared with those who were normotensive. Results: Out of 509 patients studied in this period, 265 patients had preinduction hypertension (HT group) As seen in the table, HT group had older patients,more patients who were known hypertensives and more patients on aspirin. Figure. No caption available. The hypertensive group had a higher incidence of intraoperative and postoperative hypertension needing intervention, postoperative wound haematomas, need for re surgery and extended recovery room stay. None of the patients in either groups had significant perioperative arrhythmias or ECG changes. There were 3 in- hospital deaths in the HT group, and none in the non HT group. Conclusions: Patients with preinduction hypertension had a higher risk of perioperative haemodynamic interventions, wound haematomas and repeat surgeries. Stricter control of preoperative blood pressure may be beneficial in reducing complications. However the risks and benefits of delaying surgery should be considered on an individual case basis.