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General Anesthesia in Hypertensive Patients: Impact of Pulse ressure but not Cardiac Diastolic Dysfunction on Intraoperative Hemodynamic Instability

Claude-Charles Balick Weber, Anne-Cécile Brillouet Banchereau, Anne Deverly Blanchet, Pascal Blanchet, Michel E Safar and François Stéphan

In hypertensive patients undergoing general anesthesia, elevated pulse pressure (PP) (>60 mmHg) and/or diastolic dysfunction (DD) could be risk factors for intraoperative hemodynamic instability. The aim of this observational study was to investigate the contribution of DD and preoperative PP with the occurrence of intraoperative hemodynamic instability. Hypertensive (n=61) and normotensive (n=21) patients were scheduled to undergo urologic surgery under general anesthesia. DD was graded according to preoperative Doppler echocardiography, and preoperative brachial PP was calculated during anesthetic consultation. Episodes of hypertension and hypotension were recorded during the intraoperative period. For statistical analysis, hypertensive patients were divided into groups according to the presence or not of DD. The relationship between PP and hemodynamic instability index was assessed using multiple regression analysis. Sixty-three percent of hypertensive subjects had a PP > 60 mmHg. Among hypertensives, 30 (49%) had no DD, 19 (31%) had a mild DD and 12 (20%) had a moderate or severe DD. By comparison with controls, hemodynamic instability was significantly higher in hypertensives. Hypertensive patients with and without DD had similar hemodynamic instability index. This index was positively correlated with PP, even after adjustment on age, body mass index and mean arterial pressure (r = 0.56; p < 0.0001). The study provides evidence that increased intraoperative hemodynamic instability during general anesthesia in urologic hypertensive subjects is associated with increased preoperative brachial PP. DD does not contribute to intraoperative hemodynamic instability.