Intra-operative Permissive Hypotension - How do you accomplish / prefer...?

• Previous message: Intra-operative Permissive Hypotension - How do you accomplish / prefer...?
• Next message: trauma-list Digest, Vol 67, Issue 44-- Beta Blockers and Head injury
• Messages sorted by: [ date ] [ thread ] [ subject ] [ author ]

...and then you have the Rick Dutton school who gives progressive boluses of
fentanyl or other opioids to completely block the sympathetic response.
 (maintaining baseline MAP with small fluid boluses).  He targets flow
rather than pressure and believes the massive adrenergic responses are
counter-productive.  (Not a shred of evidence to support/refute this as yet
of course)
K

2009/1/30 Jakob Stensballe <jakob.stensballe at rh.regionh.dk>

> Permissive hypotension in trauma is an excellent example of an effort
> calling for a close collaboration between surgeons and the anesthesia
> resuscitation team. The desired BP must be set in collaboration with neuro,
> minding the head if TBI is suspected...
>
> I prefer a balance of GA accomplished by sevoflurane inhalation and
> remifentanil infusion (ultra short-acting opioid), going steady on the sevo
> and titrating the remifentanil according to the desired BP (up if BP rises,
> down to standard levels if BP falls) and combining with hemostatic control
> resuscitation of ratio 1:1:1 (adjusted according to TEG) of if possible low
> volumes (tritrated volumes of 100-200 mL and up as needed according to
> volume of bleeding).
> A good point by dr. Brohi is the need to test the clots and
> sutures....normalizing the BP with a visual field.
> What do you prefer...?
>
> Great times are ahead with dr. Carrick's paper showing us the way...
>
> Best regards
>
> Jakob Stensballe
> MD, PhD
> Dept of Anesthesia, Copenhagen Trauma Center
> Rigshospitalet, Copenhagen University Hospital
> Denmark
> ----- Videresendt af Jakob Stensballe/Anæstesi-Operation/HOC/RH/H-S den
> 01/30/2009 09:25 -----
>
> Til: mailto:trauma-list at trauma.org
> Fra: Jakob Stensballe/Anæstesi-Operation/HOC/RH/H-S
> Dato: 01/30/2009 08:24
> Emne: Vedr.: Re: Intra-operative Permissive Hypotension
>
> Dr. Carrick,
>
> Please enlighten us, if possible.......!
>
> Best regards
>
> Jakob Stensballe
> MD, PhD
> Copenhagen, Denmark
>
>
>
> --
> trauma-list : TRAUMA.ORG
> To change your settings or unsubscribe visit:
> http://www.trauma.org/index.php?/community/
>

• Previous message: Intra-operative Permissive Hypotension - How do you accomplish / prefer...?
• Next message: trauma-list Digest, Vol 67, Issue 44-- Beta Blockers and Head injury
• Messages sorted by: [ date ] [ thread ] [ subject ] [ author ]