Anesthesia for an Out-of-Control Hypertension Case: Case Resolution
This is part 2 of a case conference presented by Dr. Joonyoung Ji.
Dr. Joonyoung Ji is a board-certified specialist in dental anesthesia in Ottawa. In part 2 of this case conference, Dr. Ji explains how he managed a patient with high blood pressure who was referred to him for treatment under general anesthesia. He is joined by a number of dentists in a discussion about the case.
To review the case presentation, click here
We would like to thank those dentists who accepted our invitation to participate in the conversation and attended the session.
How did Dr. Ji manage this patient?
- Dr. Ji asked the patient to monitor her blood pressure at home, and provide him with 7 readings, taken every other day. He told the patient that he would re-evaluate her once she provides the readings.
- The patient sent in one reading of 135/70 and then wasn’t heard from again. Dr. Ji’s office tried unsuccessfully to get in touch with the patient.
- Eventually, the patient got in touch again. She revealed that her doctor had been trying to put her on medication for high blood pressure for the last 10 years, but she still wasn’t taking medication.
- The patient then contacted Dr. Ji again and indicated that she had gone to see her family doctor and was now taking medication for high blood pressure.
What are the risks?
- There is a very low risk of doing a composite filling on this patient.
- For post-surgical pain management, there is a little more risk in prescribing NSAIDs or steroids for patients who have had unmanaged high blood pressure for a long time.
- The anesthetic risk involves maintaining sufficient delivery of oxygen to tissues. Anesthesia in an outpatient setting requires a healthy patient, with medical conditions under control.
What were Dr. Ji’s next steps?
- He communicated to the patient that the treatment can be done, provided certain criteria are met: if she gets her blood pressure under control with medication, in consultation with her family doctor, Dr. Ji would see hear again after roughly 2-3 months.
- Dr. Ji wrote down the conditions for providing treatment, and ensured the patient understood and agreed with these conditions.