Elective surgery should proceed for patients who attend the pre-operative assessment clinic without documentation of normotension in primary care if their blood pressure is less than 180 mmHg systolic and 110 mmHg diastolic when measured in clinic.
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What is BP now? |
Check cuff: · Width: covers 2/3 arm (too small = falsely high) · Bladder length: encircles 80% of arm circumference Repeat BP: · Repeat x 2, q 5 mins · Other arm (? arterial stenosis) · Manual check (? machine malfunction) How high is ok? · AAGBI: proceed if <180/110 |
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What is BP usually? |
· History of ↑BP? · History of white coat ↑BP · BP at last GP review? If unknown, contact GP · BP checks at home? ·
On medication? Any recent change? Taken today? |
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Symptoms? |
· Headache · Visual disturbance |
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Complications? |
· Stroke: e.g. facial droop, hemiplegia · Myocardial ischaemia: dyspnoea, sweating, ST ↑↓ on ECG · Heart failure: dyspnoea, crackles on auscultation |
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Cause? |
· Phaeo: episodic ↑HR, ↑BP, palpitations, flushing · Pre-eclampsia: visual disturbance, hyperreflexia |
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Patient |
· If anomalous and recently normal: proceed · If symptomatic: cancel · If complications: cancel, refer to A&E · If secondary cause: cancel · If PHx ischaemic heart disease: cancel (↑afterload -> ↑MvO2) · If PHx hypertensive stroke: cancel (↑risk of same) · If heart failure: cancel (↑risk APO) |
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Surgery |
· Discuss with surgeon ·
If not urgent (e.g. carpal tunnel): cancel ·
If stimulating (e.g. FESS with cocaine):
cancel · If bleeding risk (e.g. neuro): cancel |
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Anaesthetic |
·
If stimulating (e.g. laryngoscopy): favour
cancelling · If intra-op BP control very important (e.g. FESS): favour cancelling |
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Logistics |
· If post-op admission unavailable: favour cancelling · If physician review unavailable: favour cancelling |
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