enalaprilat-anhydrous and esmolol

Perioperative hypertension is commonly encountered in patients that undergo surgery. While attempts have been made to standardize the method to characterize the intraoperative hemodynamics, these methods still vary widely. In addition, there is a lack of consensus concerning treatment thresholds and appropriate therapeutic targets, making absolute recommendations about treatment difficult. Nevertheless, perioperative hypertension requires careful management. When treatment is necessary, therapy should be individualized for the patient. This paper reviews the pharmacologic agents and strategies commonly used in the management of perioperative hypertension.

Topics: Adrenergic beta-Antagonists; Antihypertensive Agents; Enalaprilat; Fenoldopam; Hemodynamics; Humans; Hydralazine; Hypertension; Incidence; Labetalol; Nicardipine; Nitroglycerin; Nitroprusside; Perioperative Care; Postoperative Complications; Propanolamines; Pyridines; Surgical Procedures, Operative; Vascular Resistance; Vasodilator Agents

Severe hypertension is a common clinical problem in the United States, encountered in various clinical settings. Although various terms have been applied to severe hypertension, such as hypertensive crises, emergencies, or urgencies, they are all characterized by acute elevations in BP that may be associated with end-organ damage (hypertensive crisis). The immediate reduction of BP is only required in patients with acute end-organ damage. Hypertension associated with cerebral infarction or intracerebral hemorrhage only rarely requires treatment. While nitroprusside is commonly used to treat severe hypertension, it is an extremely toxic drug that should only be used in rare circumstances. Furthermore, the short-acting calcium channel blocker nifedipine is associated with significant morbidity and should be avoided. Today, a wide range of pharmacologic alternatives are available to the practitioner to control severe hypertension. This article reviews some of the current concepts and common misconceptions in the management of patients with acutely elevated BP.

Topics: Antihypertensive Agents; Aortic Aneurysm; Aortic Dissection; Clonidine; Diazoxide; Enalaprilat; Female; Fenoldopam; Humans; Hypertension; Labetalol; Nicardipine; Nifedipine; Nitroprusside; Phentolamine; Pre-Eclampsia; Pregnancy; Propanolamines; Trimethaphan