Hypertension

Generally we like to keep our patient's systolic blood pressures below 120-130 mmHg. Blood pressures above this level for the average cardiac patient are excessively high. It is not uncommon for a patient who is not bleeding postop-eratively to suddenly start bleeding from suture lines when the blood pressures are elevated. In addition, the work required by the recovering postoperative heart is markedly increased when systolic hypertension occurs. The causes of postoperative hypertension are several. Post-pump state

All patients who have been on cardiopulmonary bypass experience an obligatory increase in circulating catecholamines. This results in increased myocardial contractility and peripheral vasoconstriction. This combination is a set up for postoperative blood pressure elevation. The treatment of choice therefore is the immediate institution of Nitroprusside drip titrating the dose of medication by the systolic blood pressure. Pain

Pain, like the post-pump state, produces an excessive level of circulating cat-echolamines with a commissurate increase in contractility and increase in peripheral vascular resistance. The treatment of this problem revolves around the IV administration of morphine sulphate between 2-10 mg IV push Q 3-4 hours to control postoperative pain. Rapid reversal of narcotics

Most of our patients are on narcotics and occasionally the utilization of Narcan to reverse the effects of these drugs for either respiratory or other reasons may occur. One must be cautious whenever giving antianalgesic medications for they can produce an abrupt rise in blood pressure to greater than 220 mmHg and disrupt both the aortic suture line and/or pre-existing arterial defects, such as cerebral aneurysms. Therefore, one must be extremely cautious whenever giving these medications and use them only when absolutely indicated.

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