Download PDF
Semin intervent Radiol 2022; 39(04): 373-380
DOI: 10.1055/s-0042-1757341
Review Article

Hypertensive and Hypotensive Emergencies in Interventional Radiology

Surbhi B. Trivedi
1   Department of Radiology, University of Illinois Hospital and Health Sciences System, Chicago, Illinois
,
Charles E. Ray Jr.
2   Division of Interventional Radiology, Department of Radiology, University of Illinois College of Medicine, Chicago, Illinois
› Author Affiliations
› Further Information
Also available at
    Permissions and Reprints

Abstract

Hyper- and hypotensive emergencies represent some of the most severe clinical issues that can occur during or around an interventional radiology procedure. While some patients are known to be more predisposed to cardiovascular collapse, nearly all patients are at risk for such an outcome. This is particularly true of patients undergoing moderate sedation, with the possibility of cardiovascular compromise occurring not just due to the underlying pathology for which the patient is being treated, but as a complication of sedation itself. Understanding the underlying cause of hyper- or hypotension is paramount to performing an appropriate and timely intervention. While the underlying cause is being corrected—if possible—the changes in blood pressure themselves may need to be intervened upon to maintain cardiovascular stability in these patients. Interventional radiologists must be familiar with measures taken to correct hyper- or hypotensive emergencies, including the most commonly used medications to treat these disorders. This article discusses the most common etiologies of such clinical scenarios, and the most common interventions performed for these settings.

Keywords

interventional radiology - pharmacology - complications - cardiovascular - blood pressure


Publication History

Article published online:
17 November 2022

© 2022. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Practice Guidelines for Moderate Procedural Sedation and Analgesia. Practice Guidelines for Moderate Procedural Sedation and Analgesia 2018: A Report by the American Society of Anesthesiologists Task Force on Moderate Procedural Sedation and Analgesia, the American Association of Oral and Maxillofacial Surgeons, American College of Radiology, American Dental Association, American Society of Dentist Anesthesiologists, and Society of Interventional Radiology. Anesthesiology 2018; 128 (03) 437-479
    CrossrefPubMedGoogle Scholar
  • 2 Varon J, Marik PE. Perioperative hypertension management. Vasc Health Risk Manag 2008; 4 (03) 615-627
    CrossrefPubMedGoogle Scholar
  • 3 Pai SL, Chadha RM, Irizarry-Alvarado JM, Renew JR, Aniskevich S. Pharmacologic and perioperative considerations for antihypertensive medications. Curr Clin Pharmacol 2017; 12 (03) 135-140
    CrossrefPubMedGoogle Scholar
  • 4 Duceppe E, Lussier AR, Beaulieu-Dore R. et al. Preoperative antihypertensive medication intake and acute kidney injury after major vascular surgery. J Vasc Surg 2018; 67 (06) 1872-1880 .e1
    CrossrefPubMedGoogle Scholar
  • 5 Kheterpal S, O'Reilly M, Englesbe MJ. et al. Preoperative and intraoperative predictors of cardiac adverse events after general, vascular, and urological surgery. Anesthesiology 2009; 110 (01) 58-66
    CrossrefPubMedGoogle Scholar
  • 6 Aronow WS. Management of hypertension in patients undergoing surgery. Ann Transl Med 2017; 5 (10) 227
    CrossrefPubMedGoogle Scholar
  • 7 Alnajar A, Chatterjee S, Chou BP. et al. Current surgical risk scores overestimate risk in minimally invasive aortic valve replacement. Innovations (Phila) 2021; 16 (01) 43-51
    CrossrefPubMedGoogle Scholar
  • 8 Fleisher LA. Preoperative evaluation of the patient with hypertension. JAMA 2002; 287 (16) 2043-2046
    CrossrefPubMedGoogle Scholar
  • 9 Whelton PK, Carey RM, Aronow WS. et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension 2018; 71 (06) e13-e115
    PubMedGoogle Scholar
  • 10 Lonjaret L, Lairez O, Minville V, Geeraerts T. Optimal perioperative management of arterial blood pressure. Integr Blood Press Control 2014; 7: 49-59
    CrossrefPubMedGoogle Scholar
  • 11 Reich DL, Bennett-Guerrero E, Bodian CA, Hossain S, Winfree W, Krol M. Intraoperative tachycardia and hypertension are independently associated with adverse outcome in noncardiac surgery of long duration. Anesth Analg 2002; 95 (02) 273-277 , table of contents
    CrossrefPubMedGoogle Scholar
  • 12 Kohi MP, Fidelman N, Behr S. et al. Periprocedural patient care. Radiographics 2015; 35 (06) 1766-1778
    CrossrefPubMedGoogle Scholar
  • 13 Frank SM, Higgins MS, Fleisher LA, Sitzmann JV, Raff H, Breslow MJ. Adrenergic, respiratory, and cardiovascular effects of core cooling in humans. Am J Physiol 1997; 272 (2, Pt 2): R557-R562
    PubMedGoogle Scholar
  • 14 Mangano DT. Perioperative cardiac morbidity. Anesthesiology 1990; 72 (01) 153-184
    CrossrefPubMedGoogle Scholar
  • 15 Greif R, Laciny S, Rajek A, Doufas AG, Sessler DI. Blood pressure response to thermoregulatory vasoconstriction during isoflurane and desflurane anesthesia. Acta Anaesthesiol Scand 2003; 47 (07) 847-852
    CrossrefPubMedGoogle Scholar
  • 16 McIlroy D, Murphy D, Kasza J, Bhatia D, Marasco S. Association of postoperative blood pressure and bleeding after cardiac surgery. J Thorac Cardiovasc Surg 2019; 158 (05) 1370-1379 .e6
    CrossrefPubMedGoogle Scholar
  • 17 Broderick J, Connolly S, Feldmann E. et al; American Heart Association/American Stroke Association Stroke Council; American Heart Association/American Stroke Association High Blood Pressure Research Council; Quality of Care and Outcomes in Research Interdisciplinary Working Group. Guidelines for the management of spontaneous intracerebral hemorrhage in adults: 2007 update: a guideline from the American Heart Association/American Stroke Association Stroke Council, High Blood Pressure Research Council, and the Quality of Care and Outcomes in Research Interdisciplinary Working Group. Circulation 2007; 116 (16) e391-e413
    CrossrefPubMedGoogle Scholar
  • 18 Dosing & Administration. CLEVIPREX® (clevidipine). Accessed April 5, 2022 at: https://cleviprex.com/dosing-administration/
    PubMedGoogle Scholar
  • 19 Hottinger DG, Beebe DS, Kozhimannil T, Prielipp RC, Belani KG. Sodium nitroprusside in 2014: A clinical concepts review. J Anaesthesiol Clin Pharmacol 2014; 30 (04) 462-471
    CrossrefPubMedGoogle Scholar
  • 20 Abdelwahab W, Frishman W, Landau A. Management of hypertensive urgencies and emergencies. J Clin Pharmacol 1995; 35 (08) 747-762
    CrossrefPubMedGoogle Scholar
  • 21 Keating GM. Clevidipine: a review of its use for managing blood pressure in perioperative and intensive care settings. Drugs 2014; 74 (16) 1947-1960
    CrossrefPubMedGoogle Scholar
  • 22 MacCarthy EP, Bloomfield SS. Labetalol: a review of its pharmacology, pharmacokinetics, clinical uses and adverse effects. Pharmacotherapy 1983; 3 (04) 193-219
    CrossrefPubMedGoogle Scholar
  • 23 Bhardwaj M, Bhardwaj NJ, Cueto K, Killeen TC. Hydralazine-induced liver injury: a review and discussion. BMJ Case Rep 2021; 14 (08) e243278 DOI: 10.1136/bcr-2021-243278. . PMID: 34404652; PMCID: PMC8375716
    CrossrefPubMedGoogle Scholar
  • 24 Cannon CM, Levy P, Baumann BM. et al. Intravenous nicardipine and labetalol use in hypertensive patients with signs or symptoms suggestive of end-organ damage in the emergency department: a subgroup analysis of the CLUE trial. BMJ Open 2013; 3 (03) e002338 DOI: 10.1136/bmjopen-2012-002338. . PMID: 23535700; PMCID: PMC3612758
    CrossrefPubMedGoogle Scholar
  • 25 Meng L, Yu W, Wang T, Zhang L, Heerdt PM, Gelb AW. Blood pressure targets in perioperative care. Hypertension 2018; 72 (04) 806-817
    CrossrefPubMedGoogle Scholar
  • 26 Bijker JB, Gelb AW. Review article: the role of hypotension in perioperative stroke. Can J Anaesth 2013; 60 (02) 159-167
    CrossrefPubMedGoogle Scholar
  • 27 Bijker JB, Persoon S, Peelen LM. et al. Intraoperative hypotension and perioperative ischemic stroke after general surgery: a nested case-control study. Anesthesiology 2012; 116 (03) 658-664
    CrossrefPubMedGoogle Scholar
  • 28 Becker DE, Haas DA. Management of complications during moderate and deep sedation: respiratory and cardiovascular considerations. Anesth Prog 2007; 54 (02) 59-68 , quiz 69
    CrossrefPubMedGoogle Scholar
  • 29 Becker DE, Haas DA. Recognition and management of complications during moderate and deep sedation. Part 2: cardiovascular considerations. Anesth Prog 2011; 58 (03) 126-138
    CrossrefPubMedGoogle Scholar
  • 30 Overgaard CB, Dzavík V. Inotropes and vasopressors: review of physiology and clinical use in cardiovascular disease. Circulation 2008; 118 (10) 1047-1056
    CrossrefPubMedGoogle Scholar
  • 31 Amornyotin S. Cardiorespiratory complications during moderate and deep sedation for gastrointestinal endoscopic procedures. IntechOpen; 2013. DOI: 10.5772/52737
    CrossrefGoogle Scholar
  • 32 Overgaard CB, Dzavík V. Inotropes and vasopressors: review of physiology and clinical use in cardiovascular disease. Circulation 2008 Sep 2;118(10):1047–56. Doi: 10.1161/CIRCULATIONAHA.107.728840. PMID: 18765387
    PubMedGoogle Scholar
  • 33 Practice Guidelines for Preoperative Fasting and the Use of Pharmacologic Agents to Reduce the Risk of Pulmonary Aspiration: Application to Healthy Patients Undergoing Elective Procedures: An Updated Report by the American Society of Anesthesiologists Task Force on Preoperative Fasting and the Use of Pharmacologic Agents to Reduce the Risk of Pulmonary Aspiration. Anesthesiology 2017; 126 (03) 376-393
    CrossrefPubMedGoogle Scholar
  • 34 Green SM, Irwin MG, Mason KP. International Committee for the Advancement of Procedural Sedation. Procedural sedation: providing the missing definition. Anaesthesia 2021; 76 (05) 598-601
    CrossrefPubMedGoogle Scholar
  • 35 American Society of Anesthesiologists Task Force on Sedation and Analgesia by Non-Anesthesiologists. Practice guidelines for sedation and analgesia by non-anesthesiologists. Anesthesiology 2002; 96 (04) 1004-1017
    CrossrefPubMedGoogle Scholar
  • 36 Wood JP, Traub SJ, Lipinski C. Safety of epinephrine for anaphylaxis in the emergency setting. World J Emerg Med 2013; 4 (04) 245-251
    CrossrefPubMedGoogle Scholar
  • 37 Sheikh A, ten Broek Vm, Brown SG, Simons FER. H1-antihistamines for the treatment of anaphylaxis with and without shock. Cochrane Database Syst Rev 2007; 2007 (01) CD006160
    PubMedGoogle Scholar
  • 38 Pope M, Johnston KW. Anaphylaxis after thrombin injection of a femoral pseudoaneurysm: recommendations for prevention. J Vasc Surg 2000; 32 (01) 190-191
    CrossrefPubMedGoogle Scholar
  • 39 Jalaeian H, Misselt A. Anaphylactic reaction to bovine thrombin in ultrasound-guided treatment of femoral pseudoaneurysm. J Vasc Interv Radiol 2015; 26 (06) 915-916
    CrossrefPubMedGoogle Scholar
  • 40 Tang A. A Practical Guide to Anaphylaxis. Am Fam Physician 2003; 68 (07) 1325-1332
    PubMedGoogle Scholar
  • 41 Choo KJL, Simons FER, Sheikh A. Glucocorticoids for the treatment of anaphylaxis. Cochrane Database Syst Rev 2012; 2012 (04) CD007596
    PubMedGoogle Scholar
  • 42 ACLS Bradycardia Algorithm. Accessed April 18, 2022 at: https://www.acls.net/acls-bradycardia-algorithm
    PubMedGoogle Scholar
  • 43 Holden D, Ramich J, Timm E, Pauze D, Lesar T. Safety considerations and guideline-based safe use recommendations for “bolus-dose” vasopressors in the emergency department. Ann Emerg Med 2018; 71 (01) 83-92
    CrossrefPubMedGoogle Scholar
  • 44 Algorithms. cpr.heart.org. Accessed April 18, 2022 at: https://cpr.heart.org/en/resuscitation-science/cpr-and-ecc-guidelines/algorithms
    PubMedGoogle Scholar