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DA Orientation > 7- intraoperative Hypotension/ hypertension > Flashcards

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 ?

A

True

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?

A
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
Q

Intra-op Hypertension - Causes?

What are the known cause?

A

Secondary HTN (known cause):

-Endocrine - Cushing’s dx, pheochromocytoma,
acromegaly estrogen therapy

-Neurogenic - Increased ICP, autonomic hyperreflexia

-Misc - Obesity, Hypercalcemia, preeclampsia, ect.

26
Q

Differential Dx to Hypertension

A
27
Q

Consequences of hypertension?

A

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
Q

Perioperative tx of HTN?

A

Treat Pain - Opiods, NSAIDs, Tylenol

Deepen anesthesia

Drugs

29
Q

Quiz?
How do you treat high blood pressure and low HR?

A

Diuretic, deepen anesthesia

30
Q

How do you treat low blood pressure and high HR?

A

Give fluids, phenylephrine

31
Q

How do you treat low blood pressure and low HR?

A

epi, ephedrine, fluids

32
Q

How do you treat high blood pressure and high HR?

A

beta blocker, Metroplol, esmolol (has more effect on HR)

33
Q

How do you treat high blood pressure and maintain HR?

A

Turn up gases, labetalol (has mores effect on BP)

34
Q

How do you treat low heart rate and not affect BP?

A

glycopyrrolate, atropine

DA Orientation (6 decks)

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