The National Institute for Clinical Excellence is very much a curate’s egg. Their latest guidelines on the management of hypertension is one of their better publications. It points out that 25% of those diagnosed with primary hypertension, may in fact be normotensive most of the time and have erroneously high readings due to the anxiety of having their blood pressure taken. These people are being treated inappropriately.
There is something of a parallel here in hospital practice. I have noticed over the last few years that anaesthetists now religiously take the patients’ blood pressure in the anaesthetic room, just before surgery. I may be wrong but I am sure that they did not do this in the past.
Now if patients get anxious just by having the GP take their BP, how anxious are they going to be immediately prior to anaesthesia & surgery. This anxiety is then compounded by the anaesthetist expressing concern about how high their BP is.
Could I suggest to my anaesthetic colleagues that the BP reading you get from someone in your anaesthetic room is meaningless, inaccurate, and counter productive. Why don’t you stop doing it?
As a very junior anaesthetics trainee, I will take the patients' BPs in the anaesthetic room to see just how far I can make them drop with some white stuff.
ReplyDeleteIt might be meaningless when it comes to titrating their amlodipine and furosemide over the next three months, but it's still their BP at that time.
Wouldn't there often be an older "normal" BP in their notes from their booking appointment a week or two before? I can imagine the gasperson wanting one just before the off to see how wired (sympathetic nervous system-wise) the patient was. I seem to recall that Mrs Dr Aust used to tell me in her anaesthetics days that, the more wired the patient was the morning of their op, the more anaesthetic they were likely to need.
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