Acute Arterial Hypertension in Patients undergoing Neurosurgery

Abstract

Introduction Between 20–50% of neurosurgical patients may develop early perioperative complications, and ∼ 25% have more than one clinical complication. The most commons are high blood pressure (25%) and cardiovascular events (7%). Intraoperative hypertension is characterized by an increase of 20% in basal blood pressure.

Objectives The aim of this paper is to review and discuss the pathophysiology, diagnosis and treatment of perioperative hypertension in patients undergoing neurosurgery, and to propose one table with therapeutic options.

Methods A review using Scielo, PubMed, Ebsco and Artmed databases with inclusion and exclusion criteria. Articles published from 1957 to 2015 were selected.

Discussion Five factors were established as causes: arterial hypertension, clinical conditions, surgical procedures, and operative and anesthetic factors. Specific causes preoperative, intraoperative and posoperative. The pathophysiology may have some relationship with catecholamines and sympathetic nervous system stimulation.

Conclusion Perioperative hypertension in neurosurgery may have many causes, some of them recognizable and preventable. This increased pressure may be associated with intracranial hematomas in some cases. The recognition and treatment of this disease can be helpful in the management of the postoperative period.

Resumo

Introdução Entre 20–50% dos pacientes neurocirúrgicos podem desenvolver complicações perioperatórias precoces, e cerca de 25% têm mais de uma complicação clínica. A complicação mais comum é pressão arterial elevada (25%); eventos cardiovasculares (7%). Hipertensão Arterial intraoperatória é considerada quando se aumenta 20% o valor absoluto do seu valor da pressão de base.

Objetivos O objetivo deste artigo é discutir a fisiopatologia, diagnóstico e tratamento da hipertensão perioperatória em pacientes que passaram por neurocirurgia, e propor uma tabela com opções terapêuticas.

Métodos Revisão utilizando as bases de dados SciELO, PubMed, Ebsco e Artmed com os critérios de inclusão e exclusão. Artigos publicados de 1957 a 2015.

Discussão Cinco fatores foram estabelecidos como causas: hipertensão, condições clínicas, os procedimentos cirúrgicos, fatores operatórios e fatores anestésicos. Existem causas específicas préoperatório, intraoperatório e pós-operatório estabelecidas. A fisiopatologia pode ter alguma relação com catecolaminas e com a estimulação simpático do sistema nervoso.

Conclusão A hipertensão perioperatória na neurocirurgia pode ter várias causas, algumas delas reconhecíveis. Este aumento da pressão arterial pode estar associado à incidência de hematomas intracranianos. Reconhecimento e manejo adequado da doença pode ajudar no controle da pressão durante o período pós-operatório.

Keywords

postoperative period - arterial hypertension - neurosurgery - emergence hypertension

Palavras-chave

período pós-operatório - hipertensão arterial - neurocirurgia - emergência hipertensiva

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