Management of Intraop Hypotension

Question 1

Main/Secondary effects: Epinephrine

Answer 1

increased CO
coronary vasodilation
/
Bronchodilation
reflex bradycardia

Question 2

Main/Secondary effects: Norepi

Answer 2

Vasoconstriction
/
reflex bradycardia

Question 3

Main/Secondary effects: Ephedrine

Answer 3

Increased CO and BP
Coronary vasodilation
/
tachycardia

Question 4

Main/Secondary effects: Phenylephrine

Answer 4

vasoconstriction
/
reflex bradycardia

Question 5

Hypotension causes: HR

Answer 5

arrhythmias, brady, tachy

Question 6

Hypotension causes: SV

Answer 6

reduced contractility, preload and afterload

Question 7

Hypotension causes: SVR

Answer 7

decreased vascular tone

Question 8

Insufflation effects on hemodynamics

Answer 8

decreased CO (decreased SV) and increased SVR

Question 9

Hypotension Action checklist

Answer 9

1. verify art-line correlates with NIBP, feel for pulse
2. give fluid bolus
3. pharmacological drugs (phenyl, ephedrine, vaso)
4. decrease MAC
5. decrease peep, 100% o2
6. check with the surgeon to identify if it is a surgical cause (bleeding, insufflation)
7. check hematocrit
8. change pt position (Trendelenburg, elevate legs)
9. notify the surgeon
10. call for help

Question 10

Management of hypotension: Optimize Preload

Answer 10

administer an intravenous fluid bolus e.g. crystalloid or colloid, and assess the response.

Question 11

Management of hypotension: Increase contractility

Answer 11

administer ephedrine or epinephrine

Question 12

Management of hypotension: Increase SVR

Answer 12

administer vasoconstrictor e.g. phenyl, norepi, ephedrine