Induced hypotension in surgeries.

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Hello all. Ive been a nurse for a while, but havent set foot inside an OR since my BSN program.

A buddy and I were talking at work the other day and we came to the subject of blood pressure during an operative procedure. We didnt agree on BP parameters during some types of surgeries. I was wondering if some of you could lend some expertise knowledge regarding whether or not patients are made hypotensive purposefully in some types of surgeries.

My thought would be vascular surgeries may require this. If so, are there any other situations where hypotension would be induced?

Thanks.

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Specializes in CRNA, ICU,ER,Cathlab, PACU.
Hello all. Ive been a nurse for a while, but havent set foot inside an OR since my BSN program.

A buddy and I were talking at work the other day and we came to the subject of blood pressure during an operative procedure. We didnt agree on BP parameters during some types of surgeries. I was wondering if some of you could lend some expertise knowledge regarding whether or not patients are made hypotensive purposefully in some types of surgeries.

My thought would be vascular surgeries may require this. If so, are there any other situations where hypotension would be induced?

Thanks.

sometimes arthroscopies (shoulders, knees) require a low normal bp so the operator isnt trying to look through billows of blood.

when they are cannulating an aorta during open hearts, they want the pressue dropped momentarily.

during spinal surgeries (eg scoliosis corrections) I have seen esmolol gtts for controlled hypotension for hemostasis.

in all cases perfusion of the patients head, and vital organs took priority, I havent seen any extreme hypotension (ie maps below 50)

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Thanks for the reply/answer. Does the CRNA titrate the drips in surgery or some other member of the OR team?

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Specializes in Only the O.R. and proud of it!.

We have a spinal surgeon that insists on having a Systolic pressure of at or below 100 mmHg. The drug/method used to maintain a low BP is up to anesthesia.

Also, some vascular procedures (esp w/ high risk) are kept at low normal to low BP.

Also, note that suregry is stressful on the body and without intevention would cause an increase in BP - so technically, BP always is controlled by anesthesia (versed, narcotics, etc), although at a normal (not hypotensive) level.

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The CRNA titrates all vasoactive gtts. As mentioned previously, some procedures require lowing the blood pressure for periods of time for specific reasons, (decrease bleeding, during vascular clamping) and can be accomplished by a variety of ways all in which the anesthetist is directly involved with.

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Hello all. Ive been a nurse for a while, but havent set foot inside an OR since my BSN program.

A buddy and I were talking at work the other day and we came to the subject of blood pressure during an operative procedure. We didnt agree on BP parameters during some types of surgeries. I was wondering if some of you could lend some expertise knowledge regarding whether or not patients are made hypotensive purposefully in some types of surgeries.

My thought would be vascular surgeries may require this. If so, are there any other situations where hypotension would be induced?

Thanks.

Yes in the past hypotension was utilized but much less these days. It was called permissive hypotension or induced hypotension and was usually used in spine cases. It is mostly a thing of the past now. I can't think of any vascular cases that require hypotension routinely.

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Specializes in Anesthesia.
sometimes arthroscopies (shoulders, knees) require a low normal bp so the operator isnt trying to look through billows of blood..........

One orthopod I know demands (!) that his shoulder scopes be kept at an MAP below 70. And he watches it closely on the monitor.

........ PITA

d

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Controlled or deliberate hypotension is rapidly becoming a thing of the past in many facilities. Even though the causes are debated, peri-operative visual loss is a big concern in spine surgery (and others), and hypotension is thought to be a significant contributor to this problem.

Although there are some instances when blood pressure has to be low for brief periods, extended hypotension just isn't a great concept anymore.

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Specializes in Critical Care, Emergency.

several ENT procedures like the induced hypotension

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Specializes in CRNA, ICU,ER,Cathlab, PACU.
One orthopod I know demands (!) that his shoulder scopes be kept at an MAP below 70. And he watches it closely on the monitor.

........ PITA

d

yeah I agree about the PITA...if he watches the monitor, pull up the drapes a little higher, and turn your machine so he cant see the monitor...dude needs to keep his eyes on the sharp pointy tools he has in his hand...lol

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cant you just turn the gas up a bit higher instead of pulling out esmolol?

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Specializes in Critical Care, Emergency.
cant you just turn the gas up a bit higher instead of pulling out esmolol?

yup, you can. of course, it depends on the clinical picture too. gas will vasodilate, but pretty much have no effect on HR, which inturn affects CO and SV. all three are a triad related to BP. in such cases, a beta blocker will be efficient too. also remember, you can have toxic levels of gas like any other drug. so, use everything cautiously.

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