Title : Blood pressure changes in patients undergoing 23G vitrectomy under local anaesthesia
Abstract:
The effect of elevated blood pressure (BP) during ophthalmic surgery, is associated with significant visually threatening complications. Elevated blood pressure prior to surgery can result in cancellation and postponement of surgeries and further add to the strain of limited staff and resources. Vitreoretinal surgery is technically complex and time consuming compared to cataract surgery and is often carried out under local anaesthesia. Blood pressure changes in patients undergoing vitreoretinal surgery under local anaesthesia is still poorly studied. This study aims to investigate blood pressure changes during a patient’s admission for 23G vitrectomy under local anaesthesia.
Observational prospective study. 117 consecutive patients are included. Blood pressure measurements were taken on the day of admission at various points; on arrival at the day surgery unit, preoperative, intraoperative and 30 minutes postoperative stages. Demographic and co-morbidities of patients were collected from patient electronic record. Changes in blood pressure is correlated to various patient factors such as hypertension, diabetes, previous cardiovascular and cerebrovascular events, chronic kidney disease, smokers’ status and anxiety. Correlation to surgical factors such as surgical duration and number of staff duration the operation is also investigated using statistical methods.
2/117 patients were cancelled due to SBP exceeding 200mmHg at the preoperative stage.
18% of patients had SBP of ≥160mmHg on arrival. 27% experienced ≥ 20mmHg of SBP increase at preoperative, where 34% and 20% had SBP of ≥ 160mmHg and ≥180mmHg respectively. Intraoperatively, 28% and 13% experienced SBP of ≥160mmHg and ≥180mmHg respectively. Postoperatively, 24% and 5% sustained SBP of ≥ 160mmHg and ≥180mmHg respectively. The changes in BP are not correlated with patient comorbidities. However, it did demonstrate change according to the surgical stages; mean value of +11mmHg from arrival to preoperative, -5mmHg from preoperative to intraoperative and a further -5mmHg from intraoperative to postoperative.
Our study demonstrates a pattern for patient’s blood pressure during their admission for vitrectomy. While it is reassuring to note that most patients experience the expected change of blood pressure within the safe levels, those with very high recorded BP at various points are not only exposed to the risk of developing systemic events, but also serious surgical complications such as heavy intraoperative bleeding and choroidal haemorrhage.
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