7- intraoperative Hypotension/ hypertension Flashcards

1
Q

What are the type of adrenergic receptors and where are they found?

A

Alpha-1 works (ONE)
O-blOOd Vessels, N-Neck/ bladder, E-Eye

Alpha-2
Presynaptic Nerve terminal

Beta-1
Heart

Beta-2
Lungs

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2
Q

More on Alpha-1?

A

Vasoconstricts

GI relaxation

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3
Q

More on Alpha-2?

A

Vasoconstricts

Decreased insulin secretion
Platelet aggregation

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4
Q

more on Beta-1?

A

Increased HR
AV conduction
Contractility of heart
Increased renin secretion

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5
Q

more on beta-2?

A

Bronchial relaxation, relaxation of vascular smooth muscle

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6
Q

Dopamine-1 ?

A

Vasodilation
Increased renin release

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7
Q

Dopamine-2?

A

Inhibits NE release
May constrict renal and mesenteric smooth muscles

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8
Q

What does systolic mean?

A

The force of blood against artery walls when the ventricles contract

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9
Q

What does diastolic mean?

A

The pressure in the arteries when the ventricles relax

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10
Q

What does MAP mean?

A

1/3 Systolic + 2/3 Diastolic = MAP

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11
Q

What does pulse pressure mean?

A

Difference between systolic and diastolic

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12
Q

How to calculate cardiac output?

A

CO= HR X SV

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13
Q

True/ False:

SV in kids doesn’t change while it does in adults

A

True

In infants SV is fixed so CO is HR dependent.

In adults, SV plays a much more important role when increasing HR

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14
Q

What does SV depend on?

A

1-Preload
2-Afrerload
3-Contractility

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15
Q

What does Preload entail?

A

Left ventricular (LV) end-diastolic volumes

LVEDV

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16
Q

What does Afterload entail?

A

Resistance to ejection of blood from
LV (SVR = 80(MAP-CVP)/CO)

SVR=Systemic vascular resistance
MAP= mean arterial pressure
CVP= Central venous pressure
CO= cardiac output

17
Q

what does contractility entail?

A

Force and velocity of ventricular contraction

18
Q

Intra-op Hypotension - Causes?

A

-Hypovolemia - Dehydration, inadequate IV intake,
fever, diarrhea

-Functional Hypovolemia - Sepsis (Decrease SVR,
Increase venous
capacitance), Cardiac failure, Hemorrhage,
Neurogenic loss, Anaphylaxis

-Drugs - Induction agents, volatile anesthetics,
histamine-releasing meds,
regional anesthetics

-Positive pressure ventilation

-Cardiac tamponade, tension pneumothorax

-Autonomic neuropathy - DM I, II, Guillain-Barre sx,
spinal cord injuries, HIV,
orthostatic hypotension

19
Q

What drugs are used during hypotension ?

A

Adrenergic Agonists buy time to make a true diagnosis

Phenylephrine, Ephedrine, Epinephrine, NE, Dopamine

Decrease anesthesia

20
Q

True/ false

Giving fluids will help with hypotension ?

21
Q

What signs can be used to diagnose hypotension?

A

-HR, BP, Urine output, hematocrit, base deficit, serum
lactate, response to fluid bolus, central venous
pressure, cardiac output monitor, stroke
volume variation, pulse pressure variation,
respiratory variation of the a-line tracing, physical exam (i.e. dry mucous membranes)

-“Goal Directed Therapy”

22
Q

Remember ABC, ABC?

A

Airway, Breathing, Circulation, Anesthesia, Body positioning, Celsius

23
Q

Hypertension blood pressure categories?

24
Q

Intra-op Hypertension - Causes?

What are the unknown cause?

A

-Essential HTN - unknown cause; >90% of HTN
patients

-PAIN

-Wrong cuff size

25
Intra-op Hypertension - Causes? What are the known cause?
Secondary HTN (known cause): -Endocrine - Cushing’s dx, pheochromocytoma, acromegaly estrogen therapy -Neurogenic - Increased ICP, autonomic hyperreflexia -Misc - Obesity, Hypercalcemia, preeclampsia, ect.
26
Differential Dx to Hypertension
27
Consequences of hypertension?
Physiologic - CO increases followed by SVR increases -Sustained HTN - LVH with impaired ventricular relaxation known as diastolic dysfunction, Vascular smooth muscle hypertrophy, CAD, CHF, renal issues, increased risk of stroke -Labile BP’s during surgery
28
Perioperative tx of HTN?
Treat Pain - Opiods, NSAIDs, Tylenol Deepen anesthesia Drugs
29
Quiz? How do you treat high blood pressure and low HR?
Diuretic, deepen anesthesia
30
How do you treat low blood pressure and high HR?
Give fluids, phenylephrine
31
How do you treat low blood pressure and low HR?
epi, ephedrine, fluids
32
How do you treat high blood pressure and high HR?
beta blocker, Metroplol, esmolol (has more effect on HR)
33
How do you treat high blood pressure and maintain HR?
Turn up gases, labetalol (has mores effect on BP)
34
How do you treat low heart rate and not affect BP?
glycopyrrolate, atropine