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Anesthetic Hypotension: Maria Angeles Jimenez Lozano, DVM, Certva, Decvaa, Mrcvs
Anesthetic Hypotension: Maria Angeles Jimenez Lozano, DVM, Certva, Decvaa, Mrcvs
ANESTHETIC HYPOTENSION
Maria Angeles Jimenez Lozano, DVM, CertVA, DECVAA, MRCVS
North Downs Specialist Referrals
Bletchingley, United Kingdom
ANESTHETIC HYPOTENSION
(MABP ≤60 mm Hg)
DIAGNOSIS
Low SVR (ie, too much vasodilation)
DIFFERENTIAL DIFFERENTIAL
Sympathetic blockade Vasodilation from drug (eg, acepromazine,
(epidural/spinal anesthetics) propofol, alfaxalone, inhalant)
TREATMENT TREATMENT
Reduce inhalants1-5; use Reduce anesthetic doses, balance
vasopressors to treat vasodilation, anesthetic technique
fluids for relative hypovolemia
correction
DIFFERENTIAL
Patient-related conditions (eg, sepsis,
SIRS, toxins, histamine release)
TREATMENT
Use vasopressors to treat vasodilation, fluids to treat
relative hypovolemia correction, antihistaminics or steroids
to treat histamine release
CO = cardiac output
HR = heart rate PERTINENT CALCULATIONS
MABP = mean arterial blood pressure
h Blood pressure = CO × SVR
SIRS = systemic inflammatory response syndrome
SV = stroke volume h CO = SV × HR
SVR = systemic vascular resistance
Continues on page 28
DIFFERENTIAL TREATMENT
Anesthetic drugs, 6-8 inhalants, Reduce vasopressors
injectables (eg, halothane, thiopental, and α-2 agents
α-2 agonists, propofol, ketamine in
catecholamine-depleted patients)
TREATMENT TREATMENT
Use positive inotropes (eg, Avoid strong cardiovascular
ephedrine, dobutamine, suppressant drugs, reduce anesthetic
dopamine, epinephrine) doses, balance anesthetic technique
DIFFERENTIAL
INVESTIGATION Dorsal recumbency for obese/
Spontaneous breathing, low-tidal TREATMENT pregnant/ascitic/abdominal
volume IPPV, permissive Vasopressors (eg, phenylephrine, mass patients; iatrogenic,
hypercapnia,* no PEEP vasopressin, norepinephrine) to treat surgical manipulation
vasodilation; crystalloids, colloids,
blood products
TREATMENT TREATMENT
Thoracocentesis if fluid Tilt operation table, treat mass/
present, remove mass pressure, add bolus of
crystalloids
AV = atrioventricular
*Permissive hypercapnia is a
BOAS = brachycephalic obstructive airway syndrome
ventilation strategy in which
MABP = mean arterial blood pressure oxygenation is prioritized over
expired carbon dioxide. Higher than
IPPV = intermittent positive pressure ventilation normal carbon dioxide levels are
PEEP = positive end-expiratory pressure allowed because of low ventilation
that preserves the lungs.
INVESTIGATION INVESTIGATION
Inadequate ventricular filling if No synchrony on atrial or
heart rate too high ventricular contraction
References
1. Mutoh T, Nishimura R, Kim H, Matsunaga S, Sasaki N. 6. Short CE, Bufalari A. Propofol anaesthesia. Vet Clin North Am Small
Cardiopulmonary effects of sevoflurane, compared with halothane, Anim Pract. 1999;29(3):747-778.
enflurane and isoflurane, in dogs. Am J Vet Res. 1997;58(8):885. 7. Patrick MR, Blair IJ, Feneck RO, Sebel PS. A comparison of the
2. Hikasa Y, Ohe N, Takase K, Ogasawara S. Cardiopulmonary effects of haemodynamic effects of propofol (‘Diprivan’) and thiopentone in
sevoflurane in cats: comparison with isoflurane, halothane, and patients with coronary artery disease. Postgrad Med J. 1985;61(Suppl
enflurane. Res Vet Sci. 1997;63(3):205. 3):23-27.
3. Hikasa Y, Kanwanabe H, Takase K, Ogasawara S. Comparison of 8. Mulier JP, Wouters PF, Van Aken H, Vermaut G, Vandermeersch E.
sevoflurane, isoflurane, and halothane anesthesia in spontaneously Cardiodynamic effects of propofol in comparison with thiopental:
breathing cats. Vet Surg. 1996;25(3):234-243. assessment with a transesophageal echocardiographic approach.
4. Ebert TJ, Harkin CP, Muzi M. Cardiovascular responses to Anaesth Analg. 1991;72(1):28-35.
sevoflurane: a review. Anaesth Analg. 1995;81(6 Suppl):S11-S22. 9. Ebert TJ, Muzi M, Berens R, Goff D, Kamppine JP. Sympathetic
5. Eger EI 2nd. The pharmacology of isoflurane. Br J Anaesth. 1984;56 responses to induction of anesthesia in humans with propofol or
(Suppl 1):71S-99S. etomidate. Anesthesiology. 1992;76(5):725-733.
Suggested Reading
Seymour C, Duke-Novakovski T, eds. BSAVA Manual of Canine and Feline Tranquilli WJ, Thurmon JC, Grimm KA, eds. Lumb and Jones’ Veterinary
Anaesthesia and Analgesia. 2nd ed. Gloucester, England: British Anesthesia and Analgesia. 4th ed. Ames, IA: Lippincott Williams and
Small Animal Veterinary Association; 2007. Wilkins; August 21, 2007.
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