Paix A D, Runciman W B, Horan B F, Chapman M J, Currie M
Princess Royal University Hospital, Orpington, Kent, UK.
Qual Saf Health Care. 2005 Jun;14(3):e12. doi: 10.1136/qshc.2002.004127.
Hypertension occurs commonly during anaesthesia and is usually promptly and appropriately treated by anaesthetists. However, its recognition is dependent on correctly functioning and calibrated monitors. If it is not diagnosed and/or promptly corrected, it has the potential to cause significant morbidity and even mortality.
To examine the role of a previously described core algorithm "COVER ABCD-A SWIFT CHECK" supplemented by a specific sub-algorithm for the management of hypertension occurring in association with anaesthesia.
The potential performance of this approach for each of the relevant incidents among the first 4000 reported to the Australian Incident Monitoring Study (AIMS) was compared with the actual management as reported by the anaesthetists involved.
There were 70 reports of intraoperative hypertension among the first 4000 incidents reported to AIMS. Drug related causes accounted for 59% of all incidents. It was considered that, properly applied, this structured approach would have led to a quicker and/or better resolution of the problem in 21% of the cases.
Once hypertension is identified and confirmed, its rapid control by the careful use of a volatile anaesthetic agent, intravenous opioids, or rapidly acting antihypertensives will usually avoid serious morbidity. If hypertension is unresponsive to the treatment recommended in the relevant sub-algorithm, an unusual cause such as phaeochromocytoma, carcinoid syndrome, or thyroid storm should be considered.
高血压在麻醉期间很常见，麻醉医生通常能迅速且恰当地进行治疗。然而，其识别依赖于正常运行且校准的监测仪。如果未被诊断和/或未及时纠正，它有可能导致严重的发病甚至死亡。
研究一种先前描述的核心算法“COVER ABCD - A SWIFT CHECK”以及用于处理与麻醉相关高血压的特定子算法的作用。
将这种方法对澳大利亚事件监测研究（AIMS）报告的前4000起相关事件中每起事件的潜在表现，与相关麻醉医生报告的实际处理情况进行比较。
在向AIMS报告的前4000起事件中，有70例术中高血压报告。药物相关原因占所有事件的59%。据认为，正确应用这种结构化方法，在21%的病例中可使问题更快和/或更好地得到解决。
一旦识别并确认高血压，谨慎使用挥发性麻醉剂、静脉注射阿片类药物或速效抗高血压药物迅速控制血压，通常可避免严重发病。如果高血压对相关子算法中推荐的治疗无反应，应考虑诸如嗜铬细胞瘤、类癌综合征或甲状腺危象等不寻常原因。
