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Induced hypotension for plastic surgery (Indications (Neurosurgery (AVM,…
Induced hypotension for plastic surgery
Definition
Reduction of SBP to 80-90mmHg
reduction MAP to 50-65mmHg
30% reduction of baseline MAP
Benefits
Decrease blood loss
Decrease transfusion rate
Improved surgical field
Reduction in operation time
Indications
Neurosurgery (AVM, aneurysm, vascular tumours, transphenoidal)
Major orthopaedic surgery
ENT surgery
Head and neck - dissection of neck, laryngectomy
Opthalmic surgery
Pelvic
Plastics and reconstructive surgery
Contraindications
Infants
Pregnant
Fixed cardiac output states
Coronary, renal or cerebral disease
Hypovolaemia
Severe anaemia
Techniques
Physical
Postural manoeuvers (surgical site above heart, risk VAE)
Artificial ventilation
Pharmacological
Ideal features: easy to admin, short onset time, quick offset, no toxic metabs, negligible effect vital organs, predictable effect
Used alone: inhaled anaes, propofol, SNP, NG, PGE1, adenosine, Remi
Alone or as adjunct: CCB, BB
Adjunct only: Clonidine, ACEi
Adverse effects
Hypoperfusion of vital organs, temporary or permanent
Thrombosis from impaired microcirculation
Failure of technique
Resistance and rebound hypertension
Specific adverse effects of individual drugs