Perioperative Management of Hypertension

  • M. Zakowski
Conference paper


The perioperative management of hypertension is important not only for the elderly patient but also for the parturient. Maintenance of homeostasis and the prevention of extremes of blood pressure will prevent morbidity and mortality in both the mother and the neonate. Parturients may acquire hypertensive disorders that are unique in etiology. These different causes of hypertension, their etiology and treatment will be elucidated. The pharmacodynamics of antihypertensive agents and special physiologic considerations during pregnancy will also be emphasized.


Antihypertensive Agent Systemic Vascular Resistance Uterine Artery Chronic Hypertension Hypertensive Disorder 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Cheek TG, Gutsche BB (1993) Maternal physiologic alterations during pregnancy. In: Shnider SM, Levinson G (eds) Anesthesia for obstetrics. 3rd edn. Williams & Wilkins, Baltimore, pp 3–18Google Scholar
  2. 2.
    Penny JA, Shennan AH, Halligan AW et al (1997) Blood pressure measurement in severe preeclampsia [letter]. Lancet 349:1518PubMedCrossRefGoogle Scholar
  3. 3.
    Goldkrand JW, Jackson MJ (1997) Blood pressure measurement in pregnant women in the left lateral recumbent position. Am J Obstet Gynecol 176:642–643PubMedCrossRefGoogle Scholar
  4. 4.
    Penny JA, Halligan AW, Shennan AH et al (1998) Automated, ambulatory, or conventional blood pressure measurement in pregnancy: Which is the better predictor of severe hypertension? Am J Obstet Gynecol 178:521–526PubMedCrossRefGoogle Scholar
  5. 5.
    Paarlberg KM, de Jong CL, van Geijn HP et al (1998) Total plasma fibronectin as a marker of pregnancy-induced hypertensive disorders: A longitudinal study. Obstet Gynecol 91:383–388PubMedCrossRefGoogle Scholar
  6. 6.
    Garmendia JV, Gutierrez Y, Bianca I et al (1997) Nitric oxide in different types of hypertension during pregnancy. Clinical Science 93:413–421PubMedGoogle Scholar
  7. 7.
    Roberts JM (1994) Pregnancy related hypertension. In: Creasy RK, Resnik R (eds) Maternal fetal medicine: Principles and practice. 3rd edn. WB Saunders, Philadelphia, pp 804–844Google Scholar
  8. 8.
    Peek MJ, Horvath JS, Child AG et al (1995) Maternal and neonatal outcome of patients classified according to the Australasian Society for the Study of Hypertension in Pregnancy Consensus Statement. Med J Australia 162:186–189PubMedGoogle Scholar
  9. 9.
    Lucas MJ, Leveno KJ, Cunningham FG (1995) A comparison of magnesium sulfate with Phenytoin for the prevention of eclampsia. NEJM 333:201–205PubMedCrossRefGoogle Scholar
  10. 10.
    Vincent RDJ, Chestnut DH, Sipes SL et al (1991) Magnesium sulfate decreases maternal blood pressure but not uterine blood flow during epidural anesthesia in gravid ewes. Anesthesiology 74:77–82PubMedCrossRefGoogle Scholar
  11. 11.
    Sipes SL, Chestnut DH, Vincent RDJ et al (1992) Which vasopressor should be used to treat hypotension during magnesium sulfate infusion and epidural anesthesia? Anesthesiology 77:101–108PubMedCrossRefGoogle Scholar
  12. 12.
    Neutra R, Neff R (1975) Fetal death in eclampsia: II. The effect of non-therapeutic factors. Br J Obstet Gynaecol 82:390–396PubMedCrossRefGoogle Scholar
  13. 13.
    Jain L (1997) Effect of pregnancy-induced and chronic hypertension on pregnancy outcome. J Perinatology 17:425–427Google Scholar
  14. 14.
    Arias F, Zamora J (1979) Antihypertensive treatment and pregnancy outcome in patients with mild chronic hypertension. Obstet Gynecol 53:489–494PubMedGoogle Scholar
  15. 15.
    Hull CJ (1986 Dec) Phaeochromocytoma. Diagnosis, preoperative preparation and anaesthetic management. Br J Anaesthesia 58:1453–1468CrossRefGoogle Scholar
  16. 16.
    Zakowski M, Kaufman B, Berguson P et al (1989) Esmolol use during resection of pheochro-mocytoma: report of three cases. Anesthesiology 70:875–877PubMedCrossRefGoogle Scholar
  17. 17.
    Lawson NW (1992) Autonomic nervous system physiology and pharmacology. In: Barash PG, Cullen BF, Stoelting RK (eds) Clinical anesthesia. 2nd edn. JB Lippincott, Philadelphia, pp 319–384Google Scholar
  18. 18.
    Gates JA (1996) Antihypertensive agents and the drug therapy of hypertension. In: Hardman JG, Limbird LE, Molinoff PB, Ruddon RW, Goodman Gilman A (eds) Goodman & Gilman’s The pharmacological basis of therapeutics. 9th edn. McGraw-Hill, New York, pp 362–382Google Scholar
  19. 19.
    Naulty J, Cefalo RC, Lewis PE (1981) Fetal toxicity of nitroprusside in the pregnant ewe. Am J Obstet Gynecol 139:708–711PubMedGoogle Scholar
  20. 20.
    Shnider SM, Abboud TK, Artal R et al (1983) Maternal catecholamines decrease during labor after lumbar epidural anesthesia. Am J Obstet Gynecol 147:13–15PubMedGoogle Scholar
  21. 21.
    Jouppila P, Jouppila R, Hollmen A et al (1982) Lumbar epidural analgesia to improve intervillous blood flow during labor in severe preeclampsia. Obstet Gynecol 59:158–161PubMedGoogle Scholar
  22. 22.
    Roberts SW, Leveno KJ, Sidawi JE et al (1995) Fetal acidemia associated with regional anesthesia for elective cesarean delivery. Obstet Gynecol 85:79–83PubMedCrossRefGoogle Scholar
  23. 23.
    Ramanathan J, Sibai BM, Mabie WC et al (1988) The use of labetalol for attenuation of the hypertensive response to endotracheal intubation in preeclampsia. Am J Obstet Gynecol 159:650–654PubMedGoogle Scholar

Copyright information

© Springer-Verlag Italia 1999

Authors and Affiliations

  • M. Zakowski
    • 1
  1. 1.Dept. of AnaesthesiologyCedars-Sinai Medical CenterLos AngelesUSA

Personalised recommendations