Why is it easy to cause severe hypotension in patients after induction of general anesthesia

Combined anesthesia

Combined anesthesia is a popular anesthesia method in recent years. There are many ways of combination, such as: epidural-spinal anesthesia (CSE), epidural-general anesthesia, spinal anesthesia-general anesthesia, cervical plexus-general anesthesia, general anesthesia-local anesthesia (Divine or Orthopedic).

①CSE

The invention of the CSE needle makes this method simpler and easier to operate. The main advantage of spinal anesthesia combined with epidural is to use the characteristics of spinal anesthesia with fast onset, complete block and good muscle relaxation, and continuous epidural block to supplement the shortcoming of spinal anesthesia time limitation, and continue to the postoperative PCEA sedation. pain. The disadvantage of the CSE method is that the operation technique is complicated and hypotension is prone to occur after spinal anesthesia. According to the first large number of clinical practice in Peking University, as long as the correct operation techniques are mastered, CSE can be used not only for healthy patients but also for pregnant women and elderly patients. I have experienced that the incidence of hypotension caused by hypobaric spinal anesthesia (0.15% to 0.25% bupivacaine) is significantly lower than that of hyperbaric fluid. In addition, for patients with poor cardiovascular function compensation, low-level spinal anesthesia (1/2 to 2/3 dose of spinal anesthesia) can be implemented first, and epidural anesthesia is used to gradually make up for the insufficient anesthesia range. Of course, pre-infusion before CSE, appropriate volume expansion, ready atropine and ephedrine, and ensuring oxygenation are the basis for ensuring hemodynamic stability of CSE.

② Epidural compound general anesthesia

Epidural has good analgesic and muscle relaxation effects. The unconsciousness of general anesthesia eliminates the patient's tension and discomfort, muscle relaxation makes the operation easier, and endotracheal intubation and mechanical ventilation make the patient's cardiopulmonary function more controllable; the combination of the two methods The need for epidural local anesthesia is significantly reduced, while shallow general anesthesia can meet the requirements, which greatly improves the safety of anesthesia. Therefore, it is the most respected anesthesia method in our hospital so far; this method is especially suitable for the elderly, severe and large. Anesthesia of the patient. Attention should be paid to this anesthesia: induction of general anesthesia on the basis of epidural block can lead to severe hypotension and/or bradycardia. In this case, attention should be paid to staggering the peak of induction of epidural and general anesthesia. Anesthesia is mainly based on epidural or general anesthesia according to needs. For example, epidural anesthesia is generally the main method, and epidural anesthesia should be stopped when blood loss or hypotension occurs.

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