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Blood pressure is one of the most important items in anesthesia monitoring, and it is also the one we control the most.
We hate fluctuating highs and lows.
A blood pressure monitoring curve that is almost flat and small in amplitude has always been an embarrassment for anesthesiologists to show off; 2 years ago In this public account, I propose my deep understanding of blood pressure-three words to deeply understand blood pressure, and explain the three factors that determine blood pressure: heart, blood, and tube; in simple terms, they represent the function of the heart, blood volume, and blood vessels.
Tension: There are obvious changes in blood pressure during the operation.
I should look for the reasons from the above three aspects.
This method is simple and easy to understand, which has benefited me a lot.
More simply, the source of blood pressure can be summarized as myocardial contractility, blood volume, and peripheral vascular resistance.
In actual clinical work, there are obvious changes in blood pressure, especially when there is a significant drop.
The specific reasons are sometimes difficult to analyze.
Most of the methods are to speed up the infusion first.
The effect is not good and the vasoconstrictor is added.
If there is no obvious improvement, switch to it.
Cardiotonic drugs that stimulate β1 receptors; you will find that we have been using elimination methods to find possible causes.
This situation often upsets the anesthesiologist, like a blind man touching the elephant.
As an anesthesiologist, when you encounter such problems, you will think, can the above problems be quickly identified through monitoring? Real-time monitoring can make decisions faster and more effective.
Corresponding to the above three factors of "heart", "blood" and "tube", "3S"-that is, stroke volume (SV), stroke variability (SVV), and systemic vascular resistance (SVR) can be reflected in real time.
To unexplained hypotension, the following logical decision chain can be calmly applied to quickly diagnose and intervene in time: cardiac function→myocardial contractility→SV→cardiotonic preload→blood volume→SVV→transfusion, postload after transfusion→vascular tension→SVR→ The micro-surgery or the new generation of FloTrac, which is widely used in clinical vasoconstrictors, can monitor the above data in real time, and has rich experience in use, which is the basis for the diagnosis of perioperative critical illness, massive hemorrhage and other special patients. In addition, more individualized monitoring can also be performed simultaneously, including CO, CI, SVI, SVRI; under the premise of monitoring CVP, it can simultaneously display the three major factors affecting blood pressure, which is sufficient to cope with most blood pressure changes in clinical anesthesia .
The picture comes from the common parameters of Edward EV1000 CO heart output 4-8 L/min CI heart index 2.
5-4.
0L/min/m2SV stroke volume 60-100ml/beatSVI stroke index 33-47ml/beat/m2SVV stroke volume variability< 13% SVR systemic vascular resistance 800-1200 dynes-sec/cm5 SVRI systemic vascular resistance index 1970-2390 dynes-sec/cm 5 years ago, with the continuous innovation of general anesthesia intubation technology, anesthesiologists controlled airway support and respiratory monitoring.
Known as the housekeeping skill of the anesthesiology department; I believe that with the continuous improvement of technology, minimally invasive or non-invasive, simple and accurate perioperative hemodynamic monitoring will be more widely used in the perioperative period.
A little summary, to share with you.
Previous post: What is the simple principle of SpO2? Is continuous peripheral hemoglobin concentration (SpHb) monitoring feasible? Recommendation: Three words to understand blood pressure deeply
We hate fluctuating highs and lows.
A blood pressure monitoring curve that is almost flat and small in amplitude has always been an embarrassment for anesthesiologists to show off; 2 years ago In this public account, I propose my deep understanding of blood pressure-three words to deeply understand blood pressure, and explain the three factors that determine blood pressure: heart, blood, and tube; in simple terms, they represent the function of the heart, blood volume, and blood vessels.
Tension: There are obvious changes in blood pressure during the operation.
I should look for the reasons from the above three aspects.
This method is simple and easy to understand, which has benefited me a lot.
More simply, the source of blood pressure can be summarized as myocardial contractility, blood volume, and peripheral vascular resistance.
In actual clinical work, there are obvious changes in blood pressure, especially when there is a significant drop.
The specific reasons are sometimes difficult to analyze.
Most of the methods are to speed up the infusion first.
The effect is not good and the vasoconstrictor is added.
If there is no obvious improvement, switch to it.
Cardiotonic drugs that stimulate β1 receptors; you will find that we have been using elimination methods to find possible causes.
This situation often upsets the anesthesiologist, like a blind man touching the elephant.
As an anesthesiologist, when you encounter such problems, you will think, can the above problems be quickly identified through monitoring? Real-time monitoring can make decisions faster and more effective.
Corresponding to the above three factors of "heart", "blood" and "tube", "3S"-that is, stroke volume (SV), stroke variability (SVV), and systemic vascular resistance (SVR) can be reflected in real time.
To unexplained hypotension, the following logical decision chain can be calmly applied to quickly diagnose and intervene in time: cardiac function→myocardial contractility→SV→cardiotonic preload→blood volume→SVV→transfusion, postload after transfusion→vascular tension→SVR→ The micro-surgery or the new generation of FloTrac, which is widely used in clinical vasoconstrictors, can monitor the above data in real time, and has rich experience in use, which is the basis for the diagnosis of perioperative critical illness, massive hemorrhage and other special patients. In addition, more individualized monitoring can also be performed simultaneously, including CO, CI, SVI, SVRI; under the premise of monitoring CVP, it can simultaneously display the three major factors affecting blood pressure, which is sufficient to cope with most blood pressure changes in clinical anesthesia .
The picture comes from the common parameters of Edward EV1000 CO heart output 4-8 L/min CI heart index 2.
5-4.
0L/min/m2SV stroke volume 60-100ml/beatSVI stroke index 33-47ml/beat/m2SVV stroke volume variability< 13% SVR systemic vascular resistance 800-1200 dynes-sec/cm5 SVRI systemic vascular resistance index 1970-2390 dynes-sec/cm 5 years ago, with the continuous innovation of general anesthesia intubation technology, anesthesiologists controlled airway support and respiratory monitoring.
Known as the housekeeping skill of the anesthesiology department; I believe that with the continuous improvement of technology, minimally invasive or non-invasive, simple and accurate perioperative hemodynamic monitoring will be more widely used in the perioperative period.
A little summary, to share with you.
Previous post: What is the simple principle of SpO2? Is continuous peripheral hemoglobin concentration (SpHb) monitoring feasible? Recommendation: Three words to understand blood pressure deeply
