Essay On Intraoperative Hypotension

INTRODUCTION: Although perioperative hypotension is a common problem, its true incidence is largely unknown.[1] There is evidence that postoperative outcome, including the incidence of myocardial adverse events, may be linked to the prolonged episodes of perioperative hypotension. Despite this, there are very few comprehensive resources available in the literature regarding diagnosis and management of these not so uncommon clinical occurrences, especially during non-cardiac surgery.[1] Perioperative cardiac ischemia is associated with significant morbidity and mortality; more than half of postoperative deaths are due to cardiac complications, the majority of which are ischemic.[1] It is an emergency anesthetic crisis which poses a unique management challenge for the anesthetist.

Continuous monitoring of heart rate, blood pressure and ECG trends are mandatory. If intra operative MI is suspected, this emergency situation should be discussed between the surgical and anesthetic team.

The main anesthetic aims in managing intraoperative MI are oxygenation, maintain hemodynamics, minimize cardiac work, treat arrhythmias, consider use of aspirin and heparin, consider use of gylceryl trinitrate, and an intra aortic balloon pump (where available). Use of intra operative TEE to be considered for diagnosis. The priorities are to detect intraoperative MI early, give effective treatment, and transfer the patient to ICU urgently for further cardiac care. [10]

When myocardial ischemia is because of hypovolemia, hypotension should be primarily managed with IV fluids in the form of crystalloids or colloids and blood products. Inotropic support is required when there is no response to fluid administration.In this case myocardial ischemic changes were because of hypovolemic shock. Hence by correcting hypotension secondary to hypovolemia the myocardial ischemic changes were reversed.