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Anesthesia-led hypotension is a method that can actively lower blood pressure, regulate blood pressure during surgery, and then easily restore blood pressure to the original level. The purpose of hypotension is to reduce bleeding at the incision site, to facilitate the reduction of blood loss during surgery.1. Indications and contraindications of the directed antihypertensive method
1.1 Indications of the method of blood pressure lowering is indicated in the following cases:Craniocerebral and neurological surgery: Meningiomas, cerebral aneurysms, large vessel tumors. Major bleeding cancer surgery. Vascular surgery: aortic dissection, portal anastomosis, aortic arch dissection, congenital aortic arch stenosis. The surgery lost a lot of blood, the major injuries. Uncontrolled bleeding during surgery. 1.2 Contraindications of the method Absolute contraindications
Liver failure, kidney failure. Severe hypertension. Myocardial ischemia Increased intracranial pressure. Ischemic . Lack of circulating blood volume is particularly associated. Relative contraindications
Anesthesiologists do not have much experience in the practice. The hospital does not have enough equipment to perform the method. Pregnant women.
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2. The drugs used to lower blood pressure command
2.1 Nitroprussiate (NPS) NPS also has some other names such as: Nipride, Niprint, Nitrate, Nipruss,... NPS comes in powder form, each bottle has a weight of 50 mg, when mixed with 5% sweet serum. Dosage:0.5μ/kg/min intravenously, gradually increase dose when reaching clinical results. Do not use 10μ/kg/min for more than 2 hours. Latent time 2 minutes, duration of action from 3 to 30 minutes according to the dose used. How to use:
Use an electric syringe. Change the reconstituted solution every 4 to 8 hours. Minimize exposure to light. Mechanism of action:
Acts on the walls of arteries and veins (almost no effect on the gastrointestinal tract, urinary tract or smooth muscle of the patient. Reduces resistance of peripheral blood vessels, lowers diastolic blood pressure. systolic , diastolic, mean, pulmonary arterial pressure reduction,... The drug has the effect of increasing the antihypertensive effect of gaseous anesthetics and other antihypertensive drugs 2.2 Nitroglycerine (NTG) Effects of TG mainly depends on the dose used:
Dose < 1μ/kg/min: Dilates small arteries Myocardial contractions Latent duration 3 - 5 minutes, duration of action from 15 to 30 minutes Drugs are infused into the patient through an electric syringe
2.3 Calcium blockers Frequently used calcium blockers: Nicardipine ( lozen)
Drugs in tubes of 10ml or 10mg
Dosage: Inject directly into the patient's vein from 0.5 - 1 mg until the desired clinical effect is achieved. interval or repeat Administer through an electric pump at a dose of 1 - 3 mg/h.
2.4 Halogen gas anesthetics Commonly used halogenated gaseous anesthetics: Sevoflurane, isoflurane. These are two types of vasodilators that have vasodilating effects, reducing myocardial contractility, reducing cardiac output, and reducing afterload. Lowers blood pressure within 15 minutes and stabilizes very mild increases in blood pressure and returns to normal within minutes. MAC lowering blood pressure ≥ 1.5 MAC for artificial hypotension depending on age and use of analgesics or not.
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