Co urośnie, może spaść. Leczenie niedociśnienia podczas znieczulenia

Now let’s look at our patient! In many patients, these steps will return the blood pressure to normal. We wait about 5-10 minutes after making the changes above and, if the blood pressure is increasing (the blood pressure may not be normal yet, but it should be increasing), then we can wait another 5-10 minutes before making further changes. However, if it is not increasing in 5-10 minutes, we need to move to the next step. What is the next step? It depends on the patient (see the flow chart at the end of the notes for more information).

If the patient is still dehydrated, still losing a lot of fluid or is responding to the crystalloid boluses, keep giving boluses! If not, let’s move on to the next step.

Step 4: increase the circulating volume (the volume of fluid in the blood vessels). We can use colloids to do this. Remember that crystalloids replace lost fluids and crystalloids are distributed to all the places where fluid might be lost (circulation, tissues, etc.) and this helps blood pressure if fluid loss is the only problem. But, sometimes the patient really needs more volume in the vessels and colloids are big molecules which stay in the vessels and do not distribute to all of the tissues. Because this increased volume improves perfusion of the organs, we call colloids perfusion fluids.
The volume of the colloid bolus will depend on the patient. Here are some guidelines:
2-5 ml/kg if the patient has a healthy heart (most of our patients fit in this category). Can be repeated for a total dose of 20 ml/kg.
2 ml/kg if the patient has cardiovascular disease (the heart can’t pump a lot of extra fluid whether it is crystalloids or colloids) or low protein (we don’t want to cause further dilution of the patient’s protein – remember that colloids do not contain protein). Usually not repeated in these patients. Move on to Step 5.

Again, wait 5-10 minutes. If no improvement, either repeat the colloid bolus (if appropriate) or go to Step 5 (ie, improv...

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