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Mon Feb 25 15:58:46 GMT 2008

Ivan
Then
My question is why do you see bradycrdia with hypotension in spinal
anaesthesia (Lumber L2-3) not due to the dose of local anaesthetics?
Aktham Yaghi MD
FNsP, Bratislava, Ruzinov- ICU- KAIM
Clinic of Anaesthesia and Intensive Care Medicine
Comenius University,Faculty of Medicine
Ruzinovska 6
82606 Bratislava
Slovak Republic
yaktham at gmail.com

2008/2/24 IVAN HRONEK <ih7 at msn.com>:

> Neurogenic shock is hypotension with or without bradycardia - depending on
> the cause - in high spinal cord lesions they will be bradycardic as to the
> interruption of cardiac sympathetic accelerators. In neurogenic shock due to
> brain lesion or thoracic spine injury the bradycardia is not necessarily
> present. The term is "relative bradycardia" i.e. heart rate not
> appropriate to the degree of hypotension ..which your patient actually could
> be told to have - a HR of 110/min in a young man with a barely palpable
> pulse is certainly not a high enough reflex heart rate, you'd expect at
> least 140 / min or so.
> The problem with teaching about shock is that the bradycardia is the one
> thing one can easily remember about spinal shock - however, it does not have
> to be present and then everyone is surprised.
> As dr. M. would say, a gentle clinician's touch is required here - this is
> the time to use it  - the diff.dg is clinical and that is whether or not
> the patient's skin is cold and clammy or warm and dry - hypovolemic vs.
> neurogenic shock.
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> Patients with neurogenic shock are hypotensive and usually have warm, dry
> skin.8 Bradycardia is characteristic but not universal.
> ...www.accessmedicine.com/content.aspx?aID=588768 - Similar pages
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