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AS - N928 Basic Principles of Anesthesia > Blood Pressure Management > Flashcards

Blood Pressure Management Flashcards

1
Q

What events cause hypotension and/or bradycardia?

A
  • Induction
  • Deep anesthesia
  • Insufflation
  • Vagal response
  • Blood loss
  • Prolonged duration (insensible loss)
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2
Q

Hypotension and/or bradycardia treatments

A

IDENTIFY CAUSE

HR related → anticholinergic
Preload → fluids and/or products
Vasodilation → decrease anesthetic or vasoconstrictor
Cardiac depressant → increase contractility

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3
Q

Phenylephrine MOA

A

Direct α1 agonist

↑SVR & reflex bradycardia

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4
Q

Phenylephrine Dose

A

Bolus 40-100 mcg

Infusion 20-300 mcg/min OR 0.15-0.75 mcg/kg/min

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5
Q

Phenylephrine Onset

A

< 1 minute

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6
Q

Phenylephrine DOA

A

15-20 minutes

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7
Q

Ephedrine MOA

A

Mixed α/β direct & indirect agonist

1° ↑contractility (BP & HR)

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8
Q

Ephedrine Dose

A

Bolus 5-10 mg

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9
Q

Ephedrine Onset

A

< 1 minute

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10
Q

Ephedrine DOA

A

15-60 minutes

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11
Q

Vasopressin MOA

A

α1 potent vasoconstriction

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12
Q

Vasopressin Dose

A

Bolus 1 unit

Infusion 0.04-0.1u/min

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13
Q

Vasopressin Onset

A

1-5 minutes

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14
Q

Vasopressin DOA

A

10-30 minutes

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15
Q

Norepinephrine MOA

A

Mixed α/β direct agonist (α > β)

↑SVR & tachyarrhythmias

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16
Q

Norepinephrine Dose

A

Infusion 1-30 mcg/min OR 0.01-0.2 mcg/kg/min

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17
Q

Norepinephrine Onset

A

< 1 minutes

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18
Q

Norepinephrine DOA

A

10-60 minutes

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19
Q

Epinephrine MOA

A

Mixed α/β direct agonist
Low dose β
High dose α

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20
Q

Epinephrine Dose

A

Bolus 10-100 mcg

Infusion 1-20 mcg/min OR 0.01-0.3 mcg/kg/min

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21
Q

Epinephrine Onset

A

< 1 minute

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22
Q

Epinephrine DOA

A

5-10 minutes

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23
Q

Glycopyrrolate MOA

A

Blocks muscarinic receptor to oppose PSNS

  • No CNS effects (does not cross blood-brain barrier)
  • Less ↑HR as compared to Atropine
24
Q

Glycopyrrolate Dose

A

Bolus 0.1-0.4 mg

25
Q

Glycopyrrolate Onset

26
Q

Glycopyrrolate DOA

27
Q

Atropine MOA

A

Blocks muscarinic receptors to oppose PSNS

- Crosses the blood-brain barrier & placenta

28
Q

Atropine Dose

A

Bolus 0.1-0.5 mg

ACLS 1 mg

29
Q

Atropine Onset

A

1-2 minutes

30
Q

Atropine DOA

31
Q

What events cause hypertension and/or tachycardia?

A
  • Induction/intubation
  • Light anesthesia
  • Insufflation
  • Surgical stimulation
  • Blood loss
32
Q

Hypertension and/or tachycardia treatment

A

β blockers
Ca2+ channel blockers
α2 agonist

33
Q

Esmolol MOA

A

Cardioselective β blocker β1&raquo_space; β2
HR&raquo_space; BP
Plasma esterase metabolism
Does NOT cross blood-brain barrier

34
Q

Esmolol Dose

A

Bolus 10 mg incremental doses

Infusion 100-300 mcg/kg/min

35
Q

Esmolol Onset

A

60 seconds

36
Q

Esmolol DOA

A

10-15 minutes

37
Q

Metoprolol MOA

A

Cardioselective β blocker β1&raquo_space; β2

HR > BP

38
Q

Metoprolol Dose

A

1 mg incremental doses

39
Q

Metoprolol Onset

A

< 5 minutes

40
Q

Metoprolol DOA

41
Q

Labetalol MOA

A

Non-selective β blocker

BP&raquo_space; HR

42
Q

Labetalol Dose

A

5 mg incremental doses

43
Q

Labetalol Onset

A

< 5 minutes

44
Q

Labetalol DOA

45
Q

Nicardipine MOA

A

Ca2+ channel blocker
1° blocks arterial L-type channels
- Reflex tachycardia
- No effect on ICP (ideal for neuro patients)

46
Q

Nicardipine Dose

A

Bolus 100-200 mcg

Infusion 5-15 mg/hr or 5 mcg/kg/min

47
Q

Nicardipine Onset

A

10-20 minutes

48
Q

Nicardipine DOA

49
Q

Clevidipine MOA

A

Ca2+ channel blocker
1° blocks arterial L-type channels
- Reflex tachycardia
- Rebound HTN when discontinue

50
Q

Clevidipine Dose

A

Bolus 1 mg
Infusion 1-2 mg/hr double every 90 seconds
Max 21 mg/hr (up to 32 mg/hr short duration)

51
Q

Clevidipine Onset

A

< 30 seconds

52
Q

Clevidipine DOA

A

< 1 minutes

53
Q

Hydralazine MOA

A

Direct acting NO arterial vasodilator

  • Reflex tachycardia
  • ↓DBP > SBP
  • Tachyphylaxis/tolerance
54
Q

Hydralazine Dose

55
Q

Hydralazine Onset

A

10-20 minutes

56
Q

Hydralazine DOA

AS - N928 Basic Principles of Anesthesia (18 decks)

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