Cancellation for hypertension

PIG Meeting: 11th February 2021

Case details

  • 1st case: ~66yo woman, distance patient, nil pre-op review, previously diagnosed with HTN, now not medicated (reason unclear). For Bx of vaginal lesion. BP 220/110 + headache, malaise.
  • 2nd case: 92yo lady, for hysteroscopy and D+C for postmenopausal bleeding. Phone consultation from clinic. Similar BP.
  • Surgeons amenable to postponement in both cases.

Discussion

  • Would others have cancelled these patients?
    • Some variability in anaesthetist practices.
    • AAGBI guidelines suggest that if patient’s primary care BP is not known, up to 180mmHg SBP and 110mmHg DBP are acceptable on DOS (See flowchart below and attached paper).
    • The symptoms associated with the severe HTN in the 1st case were felt to be particularly concerning. Patient was reviewed by med reg and started on regular antihypertensives, prior to d/c home.
  • Was this avoidable?
    • Even with in-person consultation this is a difficult issues, with DOS and clinic BPs often falsely elevated due to anxiety and medication changes.

AAGBI recommend not checking preop BP in clinic if documented at acceptable levels from GP (<160/100).