Blood Pressure, Not Cardiac Output, Determines Blood Loss during Induced Hypotension

Sivarajan, Murali; Amory, David W.; Everett, Gaither B.; Buffington, C.A. Tony

doi:10.1213/00000539-198003000-00007

Cited by 54 publications

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“…During hypotension produced by nitroprusside, reflex increases in heart rate and, as a result, increases in Qt usually are observed (4,5). Ganglionic blocking effect of trimethaphan may prevent reflex tachycardia and increases in Q, (6), or may even produce bradycardia and decreases in Q, (5). Total peripheral resistance is usually decreased during infusions of both drugs (4-6).…”

Section: Discussionmentioning

confidence: 99%

Regional Blood Flows during Induced Hypotension Produced by Nitroprusside or Trimethaphan in the Rhesus Monkey

Sivarajan

Amory

McKenzie

1985

Anesthesia & Analgesia

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SIVARAJAN M, AMORY DW, McKENZlE SM. Regional blood flows during induced hypotension produced by nitroprusside or trimethaphan in the rhesus monkey. Anesth Analg 1985;64:759-66. 111 monkeys anesthetized with 7070 nitrous oxide and 0.5% inspired halothane in oxygen, uie measured changes in systemic herriadynamics and regional blood pows produced by nitroprusside and trimethaphan. Regional blood flow measurements were made using the radioactive microsphere rechnique. Control measurements were made before infusion of nitroprusside and trirnethaphan into each animal in sequence in amounts adequate to reduce mean arterial pressure to approximately 55 2 5 mm Hg. Measurements were made during each drug infusion after a stable period of bypotension lasting at least 30 rnin. During nitroprusside infusion, cerebral blood flow remained unchanged, but myocardial blood flow increased significantly. Houmer, pressure-rate product, an indirect nieasure of tnyocardial oxygtii consumption, was unchanged, implying that tnyocardial blood f l~z c~ exceeded myocardial oxygen requirement. Duritig trimethaphan infusion, cerebral blood flou, decreased, dthou'yh cerebral metabolic rate for oxygen uias undmnged due to increased oxygen extraction hy the brain. Triniethapkan also produced a decrease in myocardial blood flow that was in proporfion to the decrease in myocardial oxygen requiremetif as indicated by pressure-rate product. Neither drug produced changes in renal or total hepatic blood flows. W e concltrdtp that brain oxygen reserve is decreased during hypotension induced by trimethaphan. Blood flous to other organs are not significantly impaired in monkeys dtirinx hypotension to a mean arterial pressure of approximately 55 mni Hs induced b.y either nitroprusside or trimathayhati.

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Section: Discussionmentioning

confidence: 99%

Regional Blood Flows during Induced Hypotension Produced by Nitroprusside or Trimethaphan in the Rhesus Monkey

Sivarajan

Amory

McKenzie

1985

Anesthesia & Analgesia

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“…There was no significant difference in blood loss between inhalation and epidural anaesthesia in this study. This could indicate that blood pressure, not cardiac output, is the principal determinant factor affecting the blood loss during hypotension 10 . From these findings we consider that neuroleptanaesthesia is better avoided for the patients whose blood pressures are intended to lower deliberately.…”

Section: Discussionmentioning

confidence: 99%

“…(4) Neuroleptanaesthesia is better avoided for children when induced hypotension is going to be planned. (Received Nov. 10, 1988, accepted for publication Nov. 10,1988) …”

Section: Discussionmentioning

confidence: 99%

Induced hypotension for surgical repair of congenital dislocation of the hip in children

1989

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The surgical repair of congenital dislocation of the hip was performed under normotensive anaesthesia (23 children) and hypotensive anaesthesia (52 children). Hypotension was induced with infusion of hypotensive agents such as trimetaphan or nitroglycerin during inhalation or neurolept-anaesthesia under careful monitoring of blood pressure, haematocrit and electrocardiogram. Blood replacement was done to keep hematocrit value above 30%. Blood loss was significantly less in hypotensive group (2.53 ml/kg/h) than that in normotensive group (4.53 ml/kg/h). Twenty one percent of patients in hypotensive group required blood transfusion with the rate of 3.3 ml/kg/h compared with 43% of cases in normotensive group with the rate of 4.4 ml/kg/h. Depending upon anaesthesia technique blood loss was greater in neuroleptanaesthesia (5.5 ml/kg/h) than inhalation (2.3 ml/kg/h) or epidural (2.1 ml/kg/h) anaesthesia. Urine output and laboratory data for liver and kidney functions were not different between normotensive and hypotensive group. The dose of hypotensive agents required to produce moderate hypotension for paediatric patients was much higher than that for adult. We consider that moderate hypotension is safe procedure if employed by well experienced anaesthetist with careful monitoring of blood pressure, Hct and ECG. Blood loss and requirement of blood replacement are significantly reduced with this technique.

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“…The mean arterial blood pressure is an important factor related to the intensity of surgical bleeding (10,11). It is directly proportional to cardiac output (CO) and general peripheral resistance.…”

Section: Surgical Bleedingmentioning

confidence: 99%

A role of anesthesiologist in reducing surgical bleeding in endoscopic sinus surgery

et al. 2010

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Blood Pressure, Not Cardiac Output, Determines Blood Loss during Induced Hypotension

Cited by 54 publications

References 0 publications

Regional Blood Flows during Induced Hypotension Produced by Nitroprusside or Trimethaphan in the Rhesus Monkey

Regional Blood Flows during Induced Hypotension Produced by Nitroprusside or Trimethaphan in the Rhesus Monkey

Induced hypotension for surgical repair of congenital dislocation of the hip in children

A role of anesthesiologist in reducing surgical bleeding in endoscopic sinus surgery

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