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Hospital Admission Blood Pressure

A Predictor for Hypertension following Endotracheal Intubation

Robert F. Bedford, MD^*, and Barney Feinstein, MD

* Assistant Professor. Department of Anesthesiology, University of Virginia Medical Center, Charlottesville, Virginia 22908. Resident. Department of Anesthesiology, University of Virginia Medical Center, Charlottesville, Virginia 22908.

Abstract

An analysis of 245 consecutive general anesthetics revealed that patients who were the most likely to develop arterial hypertension after endotracheal intubation often had elevated (< 140/90 torr) blood pressure (BP) at the time of hospital admission, although they were normotensive (> 140/90) while on the hospital wards. The validity of this observation was tested prospectively by monitoring heart rate and intra-arterial pressure and then recording the response to endotracheal intubation in 50 consecutive patients who were divided into three groups: group I (30 patients) had BP < 140/90 torr during and after admission; group II (12 patients) had BP > 140/90 torr on admission but < 140/90 torr during hospitalization; and group III (8 patients) had BP > 140/90 torr during and after admission. After rapid-sequence intubation with a thiopental-succinylcholine anesthetic technique, heart rate and rate-pressure product increased significantly in all three groups of patients. Mean BP in group 1 increased from 90 torr ± 2 SE just before induction to a peak value of 117 torr ± 5 just after intubation (p < 0.05). The corresponding values in group III were 118 torr ± 5 SE and 129 torr ± 9 SE, respectively (p > 0.05). In contrast, mean BP increased from 102 torr ± 5 SE to 152 ± 4 SE in group II (p < 0.001 versus control and p < 0.05 versus groups I and III). Two of these 12 patients developed ST-segment depression compatible with myocardial ischemia and eight required rapid reduction in BP with vasodilators and/or additional thiopental. It is concluded that the response of BP to the stress of the hospital admission serves as a predictor for identifying patients who are most prone to develop severe hypertension following endotracheal intubation, especially after a rapid induction of anesthesia.

Key Words: INTUBATION, Endotracheal: blood pressure • BLOOD PRESSURE: intubation

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