Arch Plast Surg.  2017 Jul;44(4):276-282. 10.5999/aps.2017.44.4.276.

Perioperative Hypertension Management during Facelift under Local Anesthesia with Intravenous Hypnotics

Affiliations
  • 1Jamie Aesthetic Plastic Surgery Clinic, Seoul, Korea. yohammer@naver.com
  • 2LIFT Aesthetic Plastic Surgery Clinic, Daegu, Korea.
  • 3IDEA Plastic Surgery Clinic, Seoul, Korea.

Abstract

Perioperative hypertension is a phenomenon in which a surgical patient's blood pressure temporarily increases throughout the preoperative and postoperative periods and remains high until the patient's condition stabilizes. This phenomenon requires immediate treatment not only because it is observed in a majority of patients who are not diagnosed with high blood pressure, but also because occurs in patients with underlying essential hypertension who show a sharp increase in their blood pressure. The most common complication following facelift surgery is hematoma, and the most critical risk factor that causes hematoma is elevated systolic blood pressure. In general, a systolic blood pressure goal of <150 mm Hg and a diastolic blood pressure goal of >65 mm Hg are recommended. This article discusses the causes of increased blood pressure and the treatment methods for perioperative hypertension during the preoperative, intraoperative, and postoperative periods, in order to find ways to maintain normal blood pressure in patients during surgery. Further, in this paper, we review the causes of perioperative hypertension, such as anxiety, epinephrine, pain, and postoperative nausea and vomiting. The treatment methods for perioperative hypertension are analyzed according to the following 3 operative periods, with a review of the characteristics and interactions of each drug: preoperative antihypertensive medicine (atenolol, clonidine, and nifedipine), intraoperative intravenous (IV) hypnotics (propofol, midazolam, ketamine, and dexmedetomidine), and postoperative antiemetic medicine (metoclopramide and ondansetron). This article focuses on the knowledge necessary to safely apply local anesthesia with IV hypnotics during facelift surgery without the assistance of an anesthesiologist.

Keyword

Hypertension; Epinephrine; Hematoma; Clonidine; Propofol

MeSH Terms

Anesthesia, Local*
Anxiety
Blood Pressure
Clonidine
Epinephrine
Hematoma
Humans
Hypertension*
Hypnotics and Sedatives*
Ketamine
Midazolam
Postoperative Nausea and Vomiting
Postoperative Period
Propofol
Rhytidoplasty*
Risk Factors
Clonidine
Epinephrine
Hypnotics and Sedatives
Ketamine
Midazolam
Propofol
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