~ ANESTHESIA FOR G NERAL AND ABDOMINAL SURGERY MAGED ARGALIOUS iomyopa mt t inrevsc volume, SVR. ““Hypoxemia from intrapulmonary shunts, 4 FRC, concurrent ‘ _COPD/pneumonia, pleural effusi Ascites, portal HTN, Gi bleedi 1- & 2-year survival = 45% & 35%Anesthetic Considerations in Abdominal Surgery Preop Evaluation * Fluid status: Pts often hypovolemic * Inadequate fluid intake (fasting, anorexia) + Fluid loss (emesis, bowel preps, GI bleeding, fevers = insensible loss) + Sequestration of fluid from intravascular space (3rd spacing) Sensorium ~]Lethargic ‘Obtunded Heart rate >] Normal or f | $5100 bpm | Mz Blood pressure — aie citek Wotgnal:.. 4 | Mildly twich Baki pe | resp variation Orthostatic changes in HR & BP | Absent Present _ Mucous membranes _ tb Dry. Very dry ANRC 5 Mild 7 1) ee Anesthetic Management Technique * Abdominal procedures usually require muscle relaxation + Epidural analgesia may be beneficial (1 anesthetic requirements, blunt surgica: stress response, T postop pain relief, | postop atelectasis, 1 postop mobility)pie bidaralCat ee ape Location rca tesa catheter Insertion Panereas, spleen, esophagus, stomach, liver, Fold Menegensont (see Chapter 9 on Fluids, Electrolytes, and Transfusion Therapy) * General stravegies * Body we-based formulas: Rough guidelines for fuid replacement * Goal-directed strategies:Almed at optimizing stroke volume, cardiac output, & tissue perfusion CEE cate aslt morbidity compared with “liberal” strategies (10-15 mU/kg/hr) * Replacement ratio: 3 mL erystalloid per 1 mL fluid loss 1 mk colloid per 1 mL fluid loss * Only 1/3 of crystalloid remains intravascular, 2/3 goes into interstitium * Colloids remain intravascular longer than crystallolds & exert oncotic pressure + Blood products—should be given based on clinical eval of blood loss (surgical suc- tion canister, sponges) & lab values (hematocrit) aa Muscle Relaxation + Usually required for intra-abdominal aba & abdominal closure | * 2° to intraop bowel edema & abdominal distention '* inhalational agents may potentiate effects of muscle relaxants * Neuraxial blockade with local anesthetics can provide good muscle relaxation