Hypertension

 

Causes

Measurement error:

·      ABP transducer on the floor

·      NIBP cuff too small

Common:

·      Essential hypertension

·      Inadequate anaesthetic

·      Urinary retention

·      Tourniquet

Deadly:

·      Cerebral ischaemia

·      Pre-eclampsia

·      Phaeochromocytoma

·      Autonomic hyperreflexia

·      Malignant hyperthermia

Assessment

·      Confirm measurement

·      Monitor: HR, SpO2, temp

·      Ventilator: etCO2

·      Surgical field: stimulation

·      Other: urine catheter

Treatment

·      Propofol

·      Opioid

·      Metaraminol off

·      Phentolamine

 

 

Hypotension:

Causes

Measurement error:

·      Transducer too high

·      NIBP cuff too big

Common:

·      Excessive anaesthetic

·      Hypovolaemia: fasting, evaporative

Deadly:

·      Hypovolaemia: major haemorrhage

·      Distributive: anaphylaxis, sepsis

·      Cardiogenic: ischaemia

·      Obstructive: gas trapping, tension pneumothorax, PE

Assessment

·      Confirm measurement

·      Monitor: PPV, HR, ECG, SpO2, temp

·      Ventilator: MAC, CO2 trace, airway pressure

·      Surgical field: bleeding, vascular compression

·      Other: ABG, CXR, echo

Treatment

·      Volume

·      Metaraminol

·      Ephedrine

·      Adrenaline