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During the course of an anesthetic, both hypertension and hypotension may be encountered. Hypertension is typically associated with patient anxiety, painful stimulus, or anesthesia that is too light. Hypertension may also be seen in the hypertensive patient who neglects to take their regular antihypertensive medications the day of the surgical procedure. Hypertension may be treated by deepening the anesthesia or by judicious use of an antihypertensive medication. Labetalol, a combined alpha‐adrenergic and beta‐adrenergic blocker, is often preferred, but selective beta‐blocking agents such as metoprolol or vasodilating agents such as hydralazine may also be used. In patients whose baseline blood pressure is elevated (above 120/80), it is important not to decrease blood pressure too rapidly or profoundly so as to avoid inducing a decrease in cardiac output.

Hypotension may also be encountered in the course of an anesthetic. Several commonly used medications such as propofol can induce a transient decrease in blood pressure, particularly when given as a bolus. In a young patient without underlying cardiac disease, small to moderate decreases in blood pressure are usually well tolerated. However, because hypotension may also be a sign of low volume status or of impending cardiovascular collapse, it should be closely monitored and treated aggressively when indicated. In pediatric patients particularly, hypotension typically precedes cardiac arrest and is an important warning sign [20]. Decreasing the anesthetic depth, increasing the rate of IV fluid infusion, and giving a bolus of IV fluids are all appropriate first steps in the management of hypotension. If these steps are not corrective, a vasopressor medication such as ephedrine or phenylephrine may be given while also investigating for any causative factors such as an underlying medical condition, anaphylaxis/allergic reaction, or increased vagal stimulation.