Perioperative Hemodynamic Responses in Hypertensive Patients Undergoing Oral Surgery and Development of the Perozo Protocol

Background Arterial hypertension (AH) is a highly prevalent systemic condition affecting approximately one-third of adults worldwide and is commonly encountered in patients undergoing oral surgical procedures. Despite its clinical significance, perioperative cardiovascular management in hypertensive dental patients remains inconsistently standardized. The Perozo protocol is a structured three-phase perioperative management framework proposed to address this gap. Objectives The objective of this article was to characterize perioperative hemodynamic responses in normotensive and controlled hypertensive patients undergoing oral surgery, evaluate the influence of anesthetic selection, surgical timing, and preoperative anxiety, and propose a structured perioperative management framework (the Perozo protocol). Methods This study represents a retrospective analysis of prospectively collected, de-identified observational clinical data from patients undergoing oral surgical procedures at two public hospitals in Maracaibo, Venezuela. Systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and heart rate (HR) were recorded at four predefined perioperative time points: (1) preoperative baseline, obtained after rest prior to the procedure; (2) during local anesthetic administration, immediately following injection; (3) active intraoperative phase, during surgical manipulation; and (4) immediate postoperative period, shortly after completion while the patient remained in the dental chair. Preoperative anxiety was assessed using the State-Trait Anxiety Inventory (STAI). Local anesthetic regimens included 2% lidocaine with 1:100,000 epinephrine or 3% plain mepivacaine. Procedures were stratified by timing (morning vs. afternoon). Statistical analyses included repeated-measures ANOVA, Pearson Chi-squared testing, and Pearson correlation coefficients (α=0.05). Results Thirty-nine patients were included: normotensive (n=21) and hypertensive receiving pharmacological treatment (n=18). Baseline blood pressure status was the primary determinant of perioperative hemodynamic variability (η²=0.33). Hypertensive patients demonstrated greater systolic blood pressure elevations, with a mean preoperative SBP of 159 mmHg compared with 128 mmHg in normotensive patients. Intraoperative SBP peaks exceeded 170 mmHg in hypertensive individuals. Hemorrhagic complications occurred significantly more frequently in hypertensive patients (66.7% vs. 9.5%; Cramer's V=0.55; p=0.008). Epinephrine-containing anesthesia produced greater increases in blood pressure and heart rate compared with plain mepivacaine. Preoperative anxiety was associated with greater systolic blood pressure increases in hypertensive patients and greater heart rate responses in normotensive patients. Observational findings from this pilot cohort informed the proposed Perozo protocol; however, formal validation has not yet been performed. Conclusions Baseline hypertensive status is a major determinant of perioperative hemodynamic variability during oral surgery. Anesthetic selection, surgical timing, anxiety management, and structured monitoring represent modifiable risk factors. The Perozo protocol represents a pilot, hypothesis-generating perioperative management framework that may improve cardiovascular safety in hypertensive dental patients. Further multicenter prospective validation is required.