Hypotensive Technique and Risks

• A patient with chronic hypertension who is receiving a deliberate hypotension technique may not tolerate a MAP lower than 25% from baseline.
• Procedures where deliberate hypotension can help to decrease blood loss:
  • Total hip replacement
  • Radical cystectomy
  • Back/spinal surgery
  • Head/neck
  • Head/inner ear
• Sodium nitroprusside is the most reliable, most potent, and quickest agent to lower blood pressure.
• Contraindications to deliberate hypotension:
  • Renal insufficiency
  • CAD
  • PVD
  • Anemia/hypovolemia
  • Brain injury
  • Spinal cord injury
  • Elderly
• Hydralazine can be used for a controlled hypotensive technique in the presence of asthma.