Question

Indications, contraindications, and complications of controlled hypotensive anaesthesia.

Hint:

Ensure close monitoring of blood pressure and organ perfusion to prevent complications during controlled hypotensive anaesthesia.

Answer 1

Step 1: Indications.
Controlled hypotensive anaesthesia is indicated in surgeries where minimizing blood loss is crucial. These include:
- Neurosurgery: To reduce bleeding in the brain and improve visibility.
- Orthopedic surgeries: Particularly those involving large joints, where reducing bleeding is vital for a clean operative field.
- Ophthalmic surgeries: Reducing bleeding in delicate eye surgeries improves surgical precision.
- Spinal surgeries: Helps control bleeding in the spinal cord area.

Step 2: Contraindications.
Controlled hypotensive anaesthesia is contraindicated in certain patients, including:
- Coronary artery disease (CAD): Lowering blood pressure in these patients can compromise coronary perfusion, increasing the risk of myocardial infarction.
- Hypovolemia: Patients with low circulating blood volume are at risk of inadequate organ perfusion, leading to shock or multi-organ failure.
- Severe hypertension: In these cases, further lowering of blood pressure can lead to ischemic damage to vital organs.

Step 3: Complications.
The main complications associated with controlled hypotensive anaesthesia include:
- Inadequate organ perfusion: Reducing blood pressure too much can impair the blood flow to critical organs, including the kidneys, liver, and brain.
- Arrhythmias: Sudden drops in blood pressure can lead to electrolyte imbalances, increasing the risk of arrhythmias.
- Post-operative hypotension: Some patients may experience prolonged hypotension after the procedure, leading to delayed recovery or other complications such as dizziness or fainting.

Step 4: Conclusion.
Controlled hypotensive anaesthesia is a valuable technique to reduce intraoperative bleeding, but it must be used carefully with consideration of the patient's cardiovascular status and the risks of complications such as inadequate perfusion or arrhythmias.