Expert: Ronald Levy, M.D. - 1/31/2007

Question
Thank you for your response to my question.  
I had heard that there were medications that can be given during surgery to lower your blood pressure, if it goes too high.  If these medications were administered and BP was lowered effectively, would you still be at risk for heart attack, stroke and bleeding?  
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The text above is a follow-up to ...

-----Question-----
Hi.  I am having outpatient surgery soon (hysterscopy, D/C & polypectomy).  I have had general and MACK anesthesia before, without any complications.  I have recently (9 months ago) been diagnosed with high blood pressure and a slightly enlarged heart (due to the HBP being undetected).  I am currently taking BP meds but they do not always control it well (sometimes it can go as high as 155-160/100-110) while on the med.  I have been cleared by my cardiologist to have the surgery (on the phone), but I am still nervous about the surgery.  I am also overweight and have gained even more since being on the BP meds.
How is high blood pressure monitored during anesthesia and/or what are the risks associated with anesthesia and HBP?  My doctor (gyn) told me I will be put to sleep, but given the short time (1 hr)and that the surgery is relatively non-invasive, I am assuming I will have a MACK?  I will not talk to the anesthesiologist until the night before surgery.  Thank you for your time.
-----Answer-----
First of all, you will have a general anesthetic for this procedure as MAC (Monitored Anesthesia Care) is not adequate for this procedure. We monitor BP continuously throughout your surgery (either by blood pressure cuff, or an arterial line in your wrist). HBP increases you risk of heart attack, stroke and bleeding. If your diastolic pressure is over 110, they will likely cancel your surgery. Having a clearance from cardiology is not enough. You need clearance from the anesthesiologist as well (which you won't get until the day of surgery). If your surgery is far enough away, you should go back to your primary physician and get better control of your HBP.

Ronald Levy, MD
Associate Professor of Anesthesiology
UTMB-Galveston


Answer
There are medicines and we do use them all the time but you are still at increased risk if your blood pressure is not under control before we start because it is the instantaeous rise (before we see it and give the medicines and they work) that you might have a stroke, etc.

Ronald Levy, MD
Associate Professor of Anesthesiology
UTMB-Galveston