Co urośnie, może spaść. Leczenie niedociśnienia podczas znieczulenia

Final notes on fluid therapy

Crystalloids and colloids are the main fluids used during anesthesia but don’t forget to replace what is lost. So if a patient has lost a lot of protein or blood, then plasma, packed red blood cells, or whole blood should be administered.

Also remember that fluid therapy is not benign. Fluids should be thought of similarly to the way we think about drugs. That is, they are a tool that can be used – and abused – and abuse can lead to adverse effects. Excessive fluids create increased work for the heart and can cause edema. Fluids should be administered to meet, but not exceed, the patient’s needs. Also, specific fluids can have specific adverse effects. For example, plasma can cause an anaphylactic reaction, colloids can cause clotting dysfunction, etc.

Monitor fluid therapy by monitoring: 1) the total dose of fluids administered; 2) blood pressure changes in response to fluids; 3) packed cell and total protein; 4) presence of edema; 5) harsh lung sounds; 6) urine production (if possible); etc.

Summary

Summary for treating hypotension:

Stabilize the patient prior to anesthesia.Turn down the vaporizer – may need to add analgesia.Replace fluid losses. Increase the rate of fluid administration and/or administer fluid boluses of crystalloids.Check the heart rate and fix if too high or too low.I.f steps 1, 2 and 3 are not producing an increase in blood pressure within 5-10 minutes, increase the perfusion pressure by increasing the circulating volume with a bolus of colloids.If steps 1-3 do not produce an increase in blood pressure or if the patient is likely to have decreased cardiac contractility (eg, patients with cardiac disease or disease that affects contractility), increase contractility with an infusion of a positive inotrope like dopamine or dobutamine.If these steps fail or if the patient is in an extreme vasodilatory state (like septic shock) decrease the vasodilation with a vasopressor like norepinephrine, ep...

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