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What Causes Low Blood Pressure After Surgery

Can Anesthesia Cause Hypoxia

Measuring blood pressure after cardiac surgery – English

Anesthetic agents, properly used, do not give rise to hypoxia rather, the impaired oxygenation is caused by such factors as pre-existing disease or trauma, the position of the patient, other mechanical interferences with ventilation, a less than optimal pattern of ventilation, and an inadequate oxygen carrying

Carotid Stenting Causes Early Drop In Blood Pressure Compared With Surgery

Carotid artery stenting leads to a greater decrease in blood pressure compared with carotid endarterectomy , although the effect is short-lived. What persists, though, according to results published online October 13, 2011, ahead of print in Stroke, is a decrease in antihypertensive medication use in CAS patients.

Researchers led by Aysun Altinbas, MD, of University Medical Center Utrecht , looked at over 1,500 patients from the International Carotid Stenting Study , which randomized subjects with a recently symptomatic carotid stenosis to CAS or CEA. In the new subanalysis, Dr. Altinbas and colleagues retrospectively compared the changes in BP following the 2 procedures over a period of up to 1 year after treatment.

While the long-term effects of CAS and CEA on BP are unclear, arterial hypotension has been frequently reported after CAS, attributed to manipulation of the carotid sinus and baroreceptor dysfunction. Meanwhile, both hypertension and hypotension have been noted after CEA.

Lower BP, Fewer Meds

In the study, baseline systolic BP and diastolic BP did not differ between the 2 groups . Nor was there any difference in the percentage of patients with treated hypertension .

In both groups, systolic and diastolic BP decreased significantly from baseline , but the decrease was larger in the CAS group at discharge .

Table 1. Change in BP from Baseline to Discharge

-4.1

< 0.0001

Table 2. Antihypertensive Medication Use During Follow-up

0.0073

Homeostasis in a Month

The Heart Adapts To The Strain Of Excess Weight

The story begins with the fact that the Obesity Disease puts tremendous strain on the heart and the

vascular system. The hearts job is to pump blood to the body, to supply oxygen and many other essential resources. The body tissues need a significant amount of oxygen for maintenance and the tissues need extra oxygen for activity such as walking or exercise. Obviously, extra fat mass leads to extra oxygen demand, but in addition, researchers have found that the support structures needed for the extra fat mass are even bigger factors that increase oxygen demand.

The simple act of walking or going up stairs is a much bigger thing for a person who suffers from the Obesity Disease. Much more energy is required to move the greater mass that obesity sufferers carry. This is simple physics, from the equation: Work = Force x Distance.

The upshot is that the heart of a person with the Obesity Disease is always working overtime even when they are asleep, and when they exercise then their heart must work MUCH harder than it would at a normal weight.

of blood it can pump. This means that the heart can only handle a certain amount of continuous high demand.

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Petechiae From A Home Blood Pressure Cuff

Although untypical, its possible you can get petechiae at home. If you are using the machine improperly, have the wrong size cuff or take your measurements too often damage to your capillaries may occur. In addition, being high risk can increase your chances more.

If you get petechiae at home, dont assume its from your blood pressure cuff. It may be a symptom of the following medical issues where a physician should be contacted.

  • Scurvy
  • Rocky Mountain Spotted Fever
  • Vitamin deficiency

Petechiae is only one complication from using a BP cuff. Check out the others in my article, Blood Pressure Cuff Complications.

How To Prevent Petechiae From A Blood Pressure Cuff

What Causes Low Blood Pressure After Surgery?

The following are different practices which can prevent petechia from occurring:

  • Using the correct size cuff.
  • Alternating which arm the cuff is attached to.
  • Periodically inspect the arm.
  • Using the correct size cuff.
  • Less frequent measurements.
  • Making sure the cuff is the correct size and not too tight.
  • Using the proper location on the arm when attaching the blood pressure cuff.
  • Consider the possibility of the monitor malfunctioning.
  • If your blood vessels are fragile, consider placing a thin cotton cloth between the cuff and arm.

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How To Tell If A Person Has Low Blood Pressure

The most common and dangerous condition that affects people with low blood pressure is fainting . It is caused by a sudden drop in blood flow to the brain. Most patients with hypotension suffer from this condition. The symptoms of syncope include the following:

Vision loss

Feeling of weakness or fatigue

Nausea.

Treating Low Blood Pressure During Surgery May Decrease Risk Of Developing Postoperative Delirium

Newswise SAN DIEGO Patients who experience low blood pressure during surgery are at increased risk for postoperative delirium, according to a large study being presented at the ANESTHESIOLOGY® 2021 annual meeting.

Postoperative delirium, a change in mental function that can cause confusion after surgery and the most common surgical complication for older adults, can be caused by a wide variety of factors, including pain, stress, insomnia and anxiety. While previous small studies have been inconclusive, the new study of 316,000 patients found low blood pressure during surgery to be a factor in the development of postoperative delirium. The researchers note low blood pressure decreases the supply of oxygen and glucose to the brain.

Postoperative delirium is a major obstacle to a quick recovery from surgery, because patients are more dependent on others for activities of daily living and it can lead to an accelerated cognitive decline, said Matthias Eikermann, M.D., Ph.D., senior author of the study and chair and Francis F. Foldes Professor of the Department of Anesthesiology at Montefiore Medical Center and Albert Einstein College of Medicine, New York. Our research suggests rapidly addressing low blood pressure during surgery may prevent delirium and help with recovery.

THE AMERICAN SOCIETY OF ANESTHESIOLOGISTS

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Petechiae From A Blood Pressure Cuff

If you ever measured your blood pressure, Im confident you can remember how tight the cuff feels when it fills with air. Many people have complained about how it squeezes and hurts their upper arm. Some patients have red marks or a petechia rash form after numerous BP measurements. This can occur more in a hospital when it is repeatedly measured.

What is petechiae from a blood pressure cuff? Petechiae from a blood pressure cuff is when reddish color dots form on your skin. This occurs from increased venous pressure during cycling of the cuff, causing the small dermal capillaries to rupture. This is more likely to occur when the patient has more vascular fragility due to a medical condition.

There are procedures the medical staff can practice to help petechiae from occurring. Even though they are sometimes unfollowed, this event is something that doesnt happen all the time. This blog post will inform you how to prevent this from happening at home. In addition, youll what action to perform if it happens to you.

BP TIP: Lower BP by just breathing? A device is FDA approved and The American Heart Association gave it the thumbs up. It simply guides your breathing a few minutes a day which has been proven to lower BP in studies. Check it out in the manufacturers website by .

Map Thresholds And Characterizations Of Hypotension

4 Causes of Post-Op Hypotension (Low Blood Pressure)-Can You Guess What They Are?

Absolute MAP thresholds were used for analyses. Multiple MAP thresholds were initially selected to examine postoperative thresholds for myocardial injury and to assess differences between intraoperative and postoperative thresholds.

Different characterizations of blood pressure exposures accounting for time components were calculated for each patient: lowest MAP for multiple cumulative minutes, duration, area, and time-weighted average under MAP thresholds. The lowest MAP was defined as a patients lowest MAP during the whole intra- or postoperative period for a minimal cumulative duration of 1, 5, 10, 15, 30, 60, 120, and 240min. Duration was defined as the cumulative length in minutes a patients MAP had decreased below the threshold. Area under a MAP threshold was defined as the depth underneath the threshold multiplied by duration, expressed as mmHg minutes, as the severity of hypotension. Additionally, to account for differences in durations of the perioperative periods and assuming measurements are not equidistant, time-weighted average under a MAP threshold, expressed in mmHg, was calculated, defined as area divided by the total duration of the intra- or postoperative period. We defined our main exposure as duration under the selected MAP threshold in minutes with area and time-weighted average under the MAP threshold as additional exposures.

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What Complications May Occur After Surgery

Sometimes, complications can occur after surgery. These are the most common complications.

Complications may include:

  • Shock. Shock is a severe drop in blood pressure that causes a dangerous reduction of blood flow throughout the body. Shock may be caused by blood loss, infection, brain injury, or metabolic problems. Treatment may include any or all of the following:

  • Stopping any blood loss

  • Helping with breathing

  • Reducing heat loss

  • Giving intravenous fluids or blood

  • Providing oxygen

  • Prescribing medicines, for example, to raise blood pressure

  • Hemorrhage. Hemorrhage means bleeding. Rapid blood loss from the site of surgery, for example, can lead to shock. Treatment of rapid blood loss may include:

  • IV fluids or blood plasma

  • Blood transfusion

  • More surgery to control the bleeding

  • Wound infection. When bacteria enter the site of surgery, an infection can result. Infections can delay healing. Wound infections can spread to nearby organs or tissue, or to distant areas through the blood stream. Treatment of wound infections may include:

  • Antibiotics

  • Surgery or procedure to clean or drain the infected area

  • Anticoagulant medicines

  • Thrombolytic medicines

  • Surgery or other procedures

  • Lung complications. Sometimes, pulmonary complications arise due to lack of deep breathing and coughing exercises within 48 hours of surgery. They may also result from pneumonia or from inhaling food, water, or blood, into the airways. Symptoms may include wheezing, chest pain, fever, and cough .

  • Low Blood Pressure This Blog Is Not About Dehydration

    A low BP in the first 3-4 weeks after bariatric surgery is usually caused by dehydration, because the healthy reduction in BP that happens with massive weight loss usually takes about 3 months or more to show up. Although this blog is not about dehydration, here are a few tips:

    • If you are struggling to drink enough fluid, contact your bariatric team right away.
    • If you can drink fluids OK, then drink a lot of fluid and add some salty fluids such as broth or pickle juice .
    • If you are taking prescribed blood pressure meds and your blood pressure is running low , talk to your bariatric team or your blood pressure doc about reducing meds.

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    How Can I Prevent Orthostatic Hypotension

    If youre prone to orthostatic hypotension, these steps can reduce symptoms:

    • Keep your temperature moderate: Dont take very hot baths or showers.
    • Stay hydrated: Drink plenty of water, limit alcohol and avoid heavy, high-carbohydrate meals.
    • Dont sleep flat: Elevate your head at night by using more pillows or tilting the mattress.
    • Prepare before standing: Give yourself more time to move into a standing position after sitting or lying down. Have something sturdy nearby to hold onto when you stand up.
    • Move your muscles: March your feet if you must stand for prolonged periods. Do isometric exercises to raise blood pressure before standing.
    • Support blood pressure: Wear compression stockings or an abdominal binder to improve blood circulation and pressure.

    What Are The Complications Of Orthostatic Hypotension

    3 Causes of Low Blood Pressure after Heart Surgery

    People with orthostatic hypotension may have a higher risk of:

    • Bone fractures or concussions due to falls when you feel dizzy or faint.
    • Postprandial hypotension, low blood pressure 30 minutes to two hours after eating .
    • Shock or organ failure if blood pressure stays too low.
    • Stroke or heart disease caused by fluctuations in blood pressure.
    • Supine hypotension, low blood pressure that occurs when lying down.How is orthostatic hypotension treated?

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    When To Contact A Medical Professional

    If low blood pressure causes a person to pass out , seek treatment right away. Or call 911 or the local emergency number. If the person is not breathing or has no pulse, begin CPR.

    • Black or maroon stools

    Your provider may recommend certain steps to prevent or reduce your symptoms including:

    • Drinking more fluids
    • Getting up slowly after sitting or lying down
    • Not drinking alcohol
    • Not standing for a long time
    • Using compression stockings so blood does not collect in the legs

    Resolution And Consequences Of Apnea Bradycardia And Intermittent Hypoxia

    Because of the growing concern over the consequences of intermittent hypoxia and recognition that intermittent hypoxia persists after discontinuation of caffeine for the treatment of apnea of prematurity, extended caffeine dosing until term-adjusted age has recently been proposed and is under investigation.15,44

    Majid Haghjoo, in, 2022

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    What Causes Low Blood Pressure After Surgery

    Low blood pressure after surgery

    Any surgery comes with the potential for certain risks, even if its a routine procedure. One such risk is a change in your blood pressure.

    According to the American Heart Association , normal blood pressure is less than 120/80 mmHg.

    The top number is called systolic pressure, and measures the pressure when your heart is beating and pumping blood. The bottom number is called diastolic pressure, and measures the pressure when your heart is resting between beats.

    Any reading below 90/60 mmHg can be considered low blood pressure, but it can be different depending on the person and on the circumstances.

    Your blood pressure can drop during or following surgery for a variety of reasons.

    What Are The Treatments For Low Blood Pressure

    Hypotension Treatment and causes

    For many people, chronic low blood pressure can be effectively treated with diet and lifestyle changes.

    Depending on the cause of your symptoms, your doctor may tell you to increase your blood pressure by making these simple changes:

    • Eat a diet higher in salt.
    • Drink lots of nonalcoholic fluids.
    • Avoid straining while on the toilet.
    • Avoid standing still in place for long periods of time.
    • Avoid prolonged exposure to hot water, such as hot showers and spas. If you get dizzy, sit down. It may be helpful to keep a chair or stool in the shower in case you need to sit to help prevent injury, use a nonslip chair or stool designed for use in showers and bath tubs.
    • To avoid problems with low blood pressure and lessen episodes of dizziness after meals, try eating smaller, more frequent meals. Cut back on carbohydrates. Rest after eating. Avoid taking drugs to lower blood pressure before meals.
    • If needed, use elastic support stockings that cover the calf and thigh. These may help restrict blood flow to the legs, thus keeping more blood in the upper body.

    Medications for Low Blood Pressure

    If these measures don’t lessen the problem, you may need medication.

    The following drugs are sometimesà used in treating low blood pressure.

    Show Sources

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    What Is The Most Common Cause Of Postoperative Hypoxemia

    The majority of postoperative hypoxemia is from pulmonary dysfunction, which includes causes from shunted and nonshunted physiology. In the immediate postoperative period, other common causes of hypoxemia are bleeding and hypovolemia. Cardiacinduced pulmonary dysfunction can also lead to significant hypoxemia.

    Are Orthostatic Hypotension And Postural Tachycardia Syndrome The Same Condition

    Postural tachycardia syndrome, or POTS, causes symptoms similar to orthostatic hypotension. Both cause dizziness or fainting upon standing. Along with a drop in blood pressure, POTS causes a heart rate increase of 30 to 40 beats per minute within 10 minutes of standing. POTS is less common than orthostatic hypotension.

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    Postoperative Hypotension After Noncardiac Surgery And The Association With Myocardial Injury

    This article is featured in This Month in Anesthesiology, page 1A.

    This article is accompanied by an editorial on p. 489.

    Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are available in both the HTML and PDF versions of this article. Links to the digital files are provided in the HTML text of this article on the Journals Web site .

    This article has an audio podcast.

    This article has a visual abstract available in the online version.

    Preliminary data for this article have been presented at the annual scientific meeting of the Dutch Society of Anesthesiology in Groningen, The Netherlands, September 21, 2018, and at the Anesthesiology Annual Meeting 2019 of the American Society of Anesthesiologists in Orlando, Florida, October 20, 2019.

    Submitted for publication September 19, 2019. Accepted for publication April 17, 2020. Published online first on May 29, 2020.

    Anesthesiology

    Victor G. B. Liem, Sanne E. Hoeks, Kristin H. J. M. Mol, Jan Willem Potters, Frank Grüne, Robert Jan Stolker, Felix van Lier Postoperative Hypotension after Noncardiac Surgery and the Association with Myocardial Injury. Anesthesiology 2020 133:510522 doi:

    In this study, postoperative hypotension was common and was independently associated with myocardial injury.

    Three Real Life Occurrences Of Petechiae From A Blood Pressure Cuff

    What Causes Low Blood Pressure After Surgery?

    #1) A 62-year old man had heart surgery and was admitted into the cardiac care unit 2. During his surgery, compression bands were used and removed about 2 hours later.

    After they were removed, there was no evidence of capillary damage.

    Several hours later, his blood pressure was measured. Immediately after, a rash and red dots formed on his arm. They started exactly where the lower edge of the blood pressure cuff was wrapped around his arm and continued down to his lower arm.

    The physicians concluded his petechia was from a combination of the following four factors:

  • Compression from the blood pressure cuff.
  • Weakness of his blood vessels.
  • Medication.
  • High blood pressure.
  • #2) A 62-year old woman was scheduled for back surgery 3 . She had diabetes for 5 years and high blood pressure for 3 years.

    During her surgery she was connected to an automatic blood pressure monitor on her left arm. It was set to measure her BP every 5 minutes.

    Prior to the surgery a rash was noted on her arm during inflation of the cuff, which disappeared immediately. The operation lasted 60 minutes and at the very end of the operation a severe rash with petechiae on her left arm was visible.

    Her cuff was moved to the right arm, and a thin piece of cotton was placed between the cuff and her arm. The petechia and rash took 10 days to go away.

    The physicians determined 2 causes for the petechiae:

  • Weak blood vessels due to diabetes and 6 years of steroid treatment for osteoarthritis.
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