review article evaluation guidelines;4 later American College of Physicians issued guidelines for assessing and management strategy for perioperative risks for non cardiac surgeries.5 Some of the evaluation of grade or severity of hypertension needs to be established, as this serves as base line. Various studies shows that Stage I and Stage II hypertension (Syst BP <180 mmHg and Diast BP <110 mmHg) are not independent risk of cardiac complication, but Stage III (Syst. BP >180 mmHg and Diast. BP >110 mmHg) are established risk factors of untoward perioperative complication.7 Hence, preoperative expectation in hypertensive patients with or without CAD is: Control of BP to a suitable baseline Stable cardiac parameters like: Heart rate Rhythm Stroke volume Pre- and afterload PCWP RAP and LAP LVEDP History of drugs like b-blockers, clonidine, ACE inhibitors etc. A successful outcome will depend on how carefully evaluation and control of cardiac parameters have been achieved. During the intraoperative period, a protocol needs to be followed for good outcome in this group of patients. Some of the methods are old, time-tested but have their limitations. It has been well-said that the best and most reliable monitor in the operative setup is an anesthesiologist. A simple palpation of pulse, recording of BP, examination of mucosa and skin can give enough information to observer but in the modern era of electronics and legal implications, minimum monitoring guideline is to be followed. The minimum monitoring guideline varies country-to-country but it is wise to have basic as well as advanced monitoring facility during intraoperative period for acceptable outcome. One can introduce very sophisticated monitoring tools, subject to availability and familiarity to use them. Asian Journal of Clinical Cardiology, Vol. 14, No. 7, November 2011
Monitoring
Some of the vital monitoring norms and their importance are as follows: Blood Pressure
The body’s homeostatic mechanism is not only systemic or organ blood flow for adequate tissue oxygen delivery but maintenance of BP also. There is always a critical systemic arterial pressure below which vital organ perfusion can be compromised. So, it is very important to maintain normal level of BP during perioperative period. There are different methods, both invasive and noninvasive for assessment of BP. Sphygmomanometer
Mercury Aneroid Electronic
Every one uses these monitoring devices and benefits and shortcomings are well-known. Oscillometer
Oscillometers are automated devices and quite common in use. They gives erroneous reading when BP has fallen below critical level or when the patient is being perfused on heart-lung machine. Continuous Noninvasive Finger BP Monitoring
This is a beat-to-beat arterial noninvasive BP monitoring device. BP in finger varies in clinical fashion with each cycle and the finger cuff receives the intra-arterial pressure which is converted to wave form, to be analyzed through consol into systolic, diastolic and mean BP. It is an advancement in BP monitoring and considered gold standard and replaces invasive intra-arterial BP monitoring. Invasive Intra-arterial BP Monitoring
It provides beat-to-beat measurement of BP and a waveform that can also be utilized for information like myocardial contractility. Severe changes in BP associated with arrhythmia such as premature ventricular contractions give an instant visual knowledge of hemodynamic consequences of rhythm disturbance. Arterial pressure waveform is 223