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Step by step treatment of hypotension

See the flow chart at the end of the notes:

Step 1: stabilize the patient. Treatment of hypotension should start before the patient is anesthetized. Factors that are known to contribute to hypotension include increasing American Society of Anesthesiologists (ASA) score, low preoperative blood pressure and high dosages of induction drugs. We can compensate for this by:
Stabilizing the patient and (hopefully) decreasing the ASA score.
Improving preoperative blood pressure by administering IV fluids.
Premedicating the patient with a sedative or analgesic drug so that high dosages of induction drugs are not necessary.
Step 2: decrease the dose of inhalant. The anesthetic gases contribute more to hypotension than any other drug that we use in anesthesia. Decreasing the inhalant dose (ie, turning down the vaporizer) generally improves the blood pressure. In order to decrease the inhalant dose, extra analgesia may be required. Analgesia is best supplied by:
Boluses of opioids.
Local or regional anesthetic blockade.
Constant rate infusion of analgesic drugs.
Step 3: give a fluid bolus. Fluids: 1) replace fluid deficits that were already present (eg, dehydration, blood loss); 2) replace fluids that will be lost during surgery (eg, urine production, evaporation from the airway, evaporation from open body cavities, blood loss); and 3) counteract some of the effects of inhalant-induced vasodilation by filling the vessels, which decreases ‘pooling’ of the blood in the vessels and causes the blood circulate better.
Normally we start with crystalloid fluids because crystalloids have an electrolyte composition that is similar to body fluids (ie, high in sodium). Thus we are replacing lost fluid with a fluid that has a similar composition to the lost fluid. That is why we call crystalloids replacement fluids.
Fluids should be administered at an appropriate rate (anywhere between 3-20 ml/kg/hour depending on the patient) and boluses s...

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