Why did it happen?
Cardiac and cerebrovascular accidents are among the most serious complications of surgery. In addition to the systemic effects of anesthesia and surgery, it is also related to the patient’s age, condition, and whether there is a combination of underlying cardiovascular and cerebrovascular disease.
Blood pressure fluctuations in the perioperative period are one of the main causes of cardiovascular accidents, as follows:
- Preoperative anesthesia requires tracheal intubation, and this stimulation causes sympathetic excitation and vasoconstriction. In turn, anesthetic drugs inhibit sympathetic activity, dilate blood vessels, reduce myocardial contractility, slow heart rate, and reduce cardiac ejection, all of which can lead to an increase or decrease in intraoperative blood pressure with increased fluctuations.
- Many patients will be nervous, anxious, excited, and fearful about surgery and anesthesia, which can lead to increased sympathetic activity and increased secretion of hormones that constrict blood vessels, causing vasoconstriction of small arteries, followed by increased peripheral vascular resistance, leading to increased blood pressure.
- Enhanced coagulation. Surgery damages the vascular endothelium and tissue, which triggers the coagulation process in the body, causing a hypercoagulable state of blood after surgery.
- Age and underlying disease. Vascular elasticity contraction and dilation is one of the main factors in maintaining blood pressure, and the decline in human vascular elasticity with age, combined with atherosclerosis and other factors, predispose to unstable blood pressure. As a result, older patients are at higher risk for cardiovascular accidents, and the risk is substantially higher if they also have diabetes and hypertension.
How to respond?
To minimize risk, your doctor will fully evaluate your heart function, coagulation status, and brain condition before surgery, which may include an electrocardiogram, cardiac ultrasound, coagulation, cranial MRI, vascular ultrasound, and several other tests.
An intraoperative cardiovascular accident may interrupt the procedure, and the surgeon may need long-term tracheal intubation to assist with breathing later.
Subsequent management needs to be done for specific conditions, such as for brain hemorrhage, which may require cranial drilling and decompression, or for myocardial infarction, which requires placement of a coronary stent.
Postoperatively, it is important to try to maintain a calm state of mind and avoid mood swings. If you feel pain in the anterior chest area, or if you become apathetic, manic, or unconscious, you should immediately inform your doctor, which will help him or her determine and take resuscitation measures as soon as possible.
Co-authors: Guangdong Provincial People’s Hospital Guangdong Lung Cancer Institute Dr. Zheng Shaopeng Dr. Xia Jin