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Systemic hypertension after open heart surgery can be caused by:
Vasoconstriction from hypothermia
Reflex vasoconstriction associated with a low cardiac output state
Hypertension may contribute to:
Increased risk of mediastinal bleeding
Vascular graft suture line disruption
Consider circumstances of hypertension and all potential contributing factors.
Decide goals for SBP and/or MAP on return from theatre.SBP 90 -120MAP 60-90
It may be due to vasoconstriction associated with a low cardiac output. Withdrawal of inotropes may lead to rapid deterioration in cardiac output. If a PA catheter or PICCO and the patient is unstable haemodynamically, consider putting one in.
Volume to increase preload will often be needed as vasodilators are introduced. Vasodilation will also occur as patients re-warm.
Sedation and analgesia – morphine/midazolam
If hypothermic, active re-warming with Blair hugger
Control shivering – rocuronium
Check cardiac output. If < 2.2 1/min/m2 maintain or increase inotropes as vasodilators are given
Vasodilator: Nitro-glycerine is the first line agent. Often ineffective at low dose, so rapidly increase to 10-20 mls/hr.
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