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Use of intravenous sedation in the management of patients with high blood pressure
Author(s) -
Woolcombe S.,
Koshal S.,
Bryant C.,
Rood P.
Publication year - 2009
Publication title -
oral surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.156
H-Index - 11
eISSN - 1752-248X
pISSN - 1752-2471
DOI - 10.1111/j.1752-248x.2010.01069.x
Subject(s) - medicine , blood pressure , sedation , midazolam , anesthesia , intravenous sedation , cohort , general anaesthesia , population , environmental health
Aim: We aim to determine the prevalence of undiagnosed/poorly controlled hypertension and study the population demographics. We also aim to study the effects of intravenous midazolam on peri‐operative blood pressure and pulse. Finally, we aim to assess the value of screening for hypertension and determine the degree of white coat hypertension. Material and methods: A cohort of 83 patients with a pre‐assessment blood pressure recording ≥160/100 mmHg was studied. Oral surgery treatment was performed under intravenous sedation with midazolam or local anaesthesia alone where sedation was contraindicated. Blood pressure and pulse were monitored throughout surgery. Following treatment, patients were advised to attend their General Practitioner (GP) for assessment of their blood pressure and information regarding the outcome of this visit was requested. Results: Seventy‐three percent of the cohort had no previous diagnosis of hypertension. The use of intravenous midazolam significantly reduced peri‐operative blood pressure compared with local anaesthesia alone [reduction in systolic blood pressure (BP) of 40 mmHg and diastolic BP of 21 mmHg]. Fifty percent of those who attended their GP received active treatment for hypertension at the first visit. A further 25% were kept under review. Blood pressure measurements at hospital pre‐assessment were substantially higher than those recorded by GPs. Conclusion: A clear indication exists for the use of intravenous sedation with midazolam for oral surgery procedures in patients with high blood pressure. There is a significant prevalence of undiagnosed and poorly controlled hypertension. Blood pressure screening in the dental setting is a valuable tool for identifying hypertensive patients. White coat hypertension is significantly greater in the oral surgery department than at the GP surgery.