Hypertension
Hypertension is most commonly due to inappropriate depth of anaesthesia or inadequate analgesia. You should rapidly exclude a problem in adequate oxygen delivery, airway and breathing first.
If problem worsens significantly or a new problem arises, call for help and go back to START of 1-1 Key Basic Plan.
Inadequate anaesthesia / analgesia (alfentanil can be diagnostic – see Box C for dose)
Inadequate neuromuscular blockade
Consider whether you could have made a drug error
Omission of usual antihypertensives
Distended bladder
Vasopressor administered by surgeon
Surgical tourniquet
Excess fluid (over-administration / overload / TURP syndrome)
Medical causes: drug interaction, renal failure, raised intracranial pressure, seizure, thyrotoxicosis, phaeochromocytoma
Alfentanil 10 µg.kg⁻¹ (adult 0.5–1 mg)
Propofol 1 mg.kg⁻¹ (adult 50–100 mg)
Labetolol 0.5 mg.kg⁻¹ (adult 25–50 mg). Repeat when necessary.
Esmolol 0.5 mg.kg⁻¹ (adult 25–50 mg). Follow with infusion.
Hydralazine 0.1 mg.kg⁻¹ (adult 5–10 mg)
Glyceryl trinitrate 0.5–5 µg.kg.min⁻¹ infusion (adult 2–20 ml.hr⁻¹ of 1 mg.ml⁻¹ solution)