I have been looking at some of the issues around hypertension, and possible issues with foot surgery under LA.
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I have worked in a number of UK NHS trusts over the last number of years,within these departments there is very often a ceiling figure for blood pressure above which a surgery would be cancelled or deferred. Over the years this theshold has changed a little, but seems to be slightly variable between organisations.
Having looked at some of the research available currently NICE has provided some guidelines regarding the medical management of hypertension generally. However I am not currently able to see much information relating to issues around hypertension in relation to foot surgery under LA. specifically regarding possible adverse events/sequelae and whether or not surgery should be cancelled in some cases
In the past I have come across patients who present on the day of surgery with a blood pressure in excess of the the normal range used by the particular department, rightly or wrongly these patients may have had their surgery cancelled on the day and referred back to their family physician for review. What I am currently struggling with, is whether these patients would be adversely affected by continuing with their surgery is their blood pressure was relatively elevated and whether there is any decent evidence to support or refute this
As podiatrists we are not in the business of medically managing hypertension, but in a fair proportion of cases I have seen where patients are referred back to their physician for investigation/treatment of hypertension, there is some degree if mild surprise that the patient had surgery cancelled for this reason alone.
Needless to say, pre operatively patients may be screened and referred accordingly based on findings
Would any one care to share with me their own guidelines on this area?
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