Pre-Extubation Blood Pressure Trends and Recovery Response in Hypertensive Patients

Open Access

Abstract

Background: Extubation provokes sympathetic surge producing haemodynamic instability, disproportionately severe in patients with pre-existing hypertension and capable of precipitating arrhythmia, hypertensive crisis or delayed recovery. Blood pressure behaviour during the pre-extubation interval preceding the stimulus has received little study. Objective: To assess blood pressure trends during the pre-extubation period and their relationship to early recovery in hypertensive patients undergoing general anaesthesia. Methods & Materials: This prospective observational study was conducted in the Department of Anaesthesia, Analgesia and Intensive Care Medicine at Bangladesh Medical University, Dhaka, over twelve months. Sixty hypertensive patients undergoing surgery requiring endotracheal intubation were enrolled. Heart rate and arterial pressures were recorded at baseline, before induction, before extubation and up to fifteen minutes after extubation. Patients were classified as normotensive, hypotensive or hypertensive by intraoperative deviation from baseline and recovery was assessed using the Modified Aldrete Scoring System. Results: Mean age was 50.3 ± 7.5 years and 62% of patients were male. Following induction, 53.3% remained normotensive, 20.0% became hypotensive and 26.7% became hypertensive. Systolic, diastolic and mean arterial pressures diverged significantly between groups from the pre-extubation interval onward (p = 0.001). Extubation time was longer in the hypotensive (4.7 ± 0.5 minutes) and hypertensive (4.8 ± 0.8 minutes) groups than in the normotensive group (3.5 ± 0.4 minutes, p = 0.001) and Modified Aldrete scores were correspondingly lower in these two groups at every postoperative interval. Conclusion: Pre-extubation blood pressure behaviour predicts post-extubation stability and recovery quality in hypertensive patients, supporting closer haemodynamic surveillance during this window.