Post-Op Hypertension

What kind of sedation is being administered?

Has the pt been that hypertensive for 36 hrs? I agree about sedation indeed. Also, is Nicardipine not an option? Are there not other post-op complications?

i am surprised he hasn't blown a graft...although is sounds like he blew a bleb....

i would up the diprivan, give morphine - turn the NTG back on...

do they have a swan in - what are the readings??

if he was and uncontrolled hypertensive pre-op - perhaps he needs a systolic of 180 due to an autoregulation curve shift...

pulmonary htn??? if so - i know there are 2 meds contraindicated - one is an ACEI (i think lisinopril) and the other is missing me right now...

what would you do pete??

Pt. was getting versed 2mg q1-2hrs prn (shady doctor). My answer was simple diprivan for respiratory distress to let the lungs rest, sedation, and even for blood pressure, since it is so high, and other methods have been resistant. I thought it would be more of a priority to get his blood pressure down.

It turned out the patient had bilateral Pneumos. Chest tube insertion x2 was completed rather quickly. Pt. is still quite hypertensive, but did end up on a diprivan drip. it just took a while.

Swan was actually pulled today because pt's co/ci were great, 7/3 range. pulmonary pressures did not indicate any pulmonary hypertension, but that is in interesting point about contraindication. they did start lisinopril today actually.

also good point about the autoregulation curve. Since he was so poorly controlled pre-op, he's probably used to a high blood pressure. I kinda wondered if there was any other agent that could be used for blood pressure. Nipride is some pretty potent stuff.

Thanks for the info.

David

Just thought I would update you. Right now, there investigating whether patient has a pheochromacytoma. That would explain that amount of hypertension that we saw.