List Archives

Fri Apr 2 17:32:54 BST 2004

MessageMost of the surgeons ussually live the patient by around 90's systolic , and, when they have been opened , than they ask to rise a bit the BP to find the bleeding, than , after they found it and repair the damaged they let the anaesthesiologists to rise the BP to normal levels.
But when your waiting for them and you already have used, every single remedy like soloids, RL, etc. is valid (even in AHA recommendations) as a last resource to use dopa and when your using epi is because you may have the wors outcoming.
It's my little experience.
Alejandro Cabrera, M.D.
Former Surgeon assistent.
Red Cross Mazatlan. (1984-86)
  ----- Original Message ----- 
  From: Surgery Visitor SURV5 
  To: Trauma & Critical Care mailing list ; trauma-l at lists.aast.org 
  Sent: Thursday, April 01, 2004 9:15 PM
  Subject: RE: Use of inotropes for severely hypotensive trauma patients

  Hi Allen, nice to see a fellow Asian lurker on the lists.
  I see it sometimes in my practice too. In the ED at initial resuscitation of patients with a clear indication for operative intervention, I strive to maintain systolic BP around the 90 mmHg level with as little crystalloids as is possible but if BP dips, usually load a bit more with colloids/blood. Avoid dopamin/epi in this setting as the treatment of choice is to get this patient quickly into the OR for surgical haemostasis rather than vasoconstrict further. Enlightened anaesthetists working with me in OR will usually continue the same practice, minimise further drops in BP at anaesthetic induction, and try as far as possible to continue keeping the syst BP at the 90 level until I tell them that I have control at my end. Then, they usually concentrate on replacing volume with blood products. Problem arises when they can't maintain even a systolic BP of >60 mm Hg as I start the operation going. Emphasis on volume loading at this stage more than inotropes. It is really big temptation for the anaesthetists to give dopamine to try and maintain CO (anyone reallly believe that there is such a thing as low enough dose of dopamine to have an inotropic effect without vasoconstriction? I certainly don't). Epinephrine is bad news once started. 
  Any role for vasopressin (say 0.2-0.8 ug/min infusion) under these circumstances? I remember an article in the May 2003 J Trauma supplement on fluid resuscitation proposing theoretical benefit for vasopressin in refractory "fluid resuscitated, late phase haemorrhagic shock". The data from vasopressin use in septic shock is mixed at best but certainly one can argue that vasopressin on board may allow any other inotropic drugs used to be used at lower doses with potentially less vasoconstrictive effects.
  Dr Kenneth Mak
  Dept of Surgery
  National University Hospital, Singapore

   -----Original Message-----
  From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org] On Behalf Of Allen Yeo
  Sent: Friday, 2 April 2004 7:05 AM
  To: Trauma & Critical Care mailing list; trauma-l at lists.aast.org
  Subject: Use of inotropes for severely hypotensive trauma patients

    I noticed that the anaesthetists are starting dopamine/epi drips (on top of fluid and blood transfusion) on trauma patients with hypovolemic shock during surgery for damage control. These are usually patients who are profoundly shocked. Is this a common practice? Would appreciate the opinion from the members of the list. Thanks.

    Allen
    Singapore 

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Use of inotropes for severely hypotensive trauma patients