Anesthetic Insights: Navigating the Complexities of Hypertension in Elderly Surgical Patients

Abstract

Background: Hypertension is a frequent finding in older surgical patients and can be a challenge during anesthetic management due to reduced cardiovascular reserve and heightened sensitivity to perioperative blood pressure changes in these patients. This study aimed to assess anesthetic factors and predictors of perioperative haemodynamic instability in elderly hypertensive patients.

Methods: A prospective observational analytical study was conducted among 200 hypertensive patients aged ≥65 years undergoing elective surgery. Patients were recruited through consecutive sampling. Demographic, hypertension-related, anesthetic, intra- and postoperative data were noted. Independent-samples t test, Mann–Whitney U test, chi-square/Fisher exact test, and multivariable logistic regression were used for data analyses.

Results: Hemodynamic instability occurred in 74 (37.0%) patients, of which 48 (24.0%) patients experienced intraoperative hypotension, and 38 (19.0%) patients experienced hypertension. Older patients and those with higher preoperative SBP and DBP, longer surgery, more blood loss, and longer hospital stays (p<0.05) were found in patients with instability. Independent predictors included age ≥75 years (AOR 1.98), ASA III (AOR 2.31), hypertension ≥10 years (AOR 2.08), SBP ≥160 mmHg (AOR 2.76), poor medication adherence (AOR 2.17), general anesthesia (AOR 2.54), and surgery >90 minutes (AOR 2.63).

Conclusion: Elderly hypertensive patients were highly vulnerable to perioperative haemodynamic changes. Carefully planned anesthesia and close blood-pressure supervision may enhance anesthetic safety.