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drcaplan
drcaplan, Board Certified Physician
Category: Medical
Satisfied Customers: 340
Experience:  I have specialized in common problems for men, women, children, and the elderly.
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If systolic BP is below 70 during a major spinal surgery,

Customer Question

If systolic BP is below 70 during a major spinal surgery, what are the risks? What would cause systolic BP to be low other than blood loss? Would anemia (HGB 79) be a problem preoperatively and how should this be managed before adn during a surgery?
Submitted: 1 month ago.
Category: Medical
Expert:  drcaplan replied 1 month ago.

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Customer: replied 1 month ago.
would prefer a back and forth
Expert:  drcaplan replied 1 month ago.

That works for me!

Expert:  drcaplan replied 1 month ago.

In brief, if your systolic blood pressure drops and is low for a sustained period, there is a small, theoretical risk of damage to organs.

Expert:  drcaplan replied 1 month ago.

during spinal surgery, there are many possibilities for what could cause this, and it could happen naturally without relationship to the surgery at all! The changes in blood pressure really depend on the baseline BP. If the baseline were 80, for example, which some people have.... 70 wouldn't be so concerning. Even BPs up to 120, 70 isn't necessarily too concerning. We have to keep in mind that it's possible that there is something that has nothing to do with the body that could be involved, like the incorrect placement , or movement, of a measuring cuff.

Expert:  drcaplan replied 1 month ago.

The simplest/best measurement for concern is whether there are clinical findings. If you're different later, and it has nothing to do with the spinal surgery at all, the blood pressure change may be relevant. but even still, it's quite unlikely, provided the BP came up to normal values afterwards

Expert:  drcaplan replied 1 month ago.

blood loss, dehydration, not really anemia... that doesn't cause short term BP changes... anemia should be managed with iron supplementation.

Expert:  drcaplan replied 1 month ago.

Was I able to address your question to your satisfaction? Can I clarify, or address any other related questions for you today?

Customer: replied 1 month ago.
Hi thanks, ***** ***** outcome of the surgery was flaccid paralysis at the level of T9 with no return of function or sensation (neuromuscular, bowel, bladder, etc) 3 months following surgery. I can show you a picture of the anestheic record if you would like to see this. Should they monitor neurological function during surgery to ensure that hypotension does not lead to poor outcomes? ie: SEPs?
Customer: replied 1 month ago.
Would anemia not compromise the ability of the body to deliver oxygen to the tissues? In the context of anemia, should BP be kept slightly higher to avoid compromise?
Customer: replied 1 month ago.
Also they were 2 sustained hypotensive events (greater than 40 minutes in length) during a 4 hour surgery...
Customer: replied 1 month ago.
Are you able to answer the above questions. Sorry I was called away for a bit
Expert:  drcaplan replied 1 month ago.

of course. let me review.

Expert:  drcaplan replied 1 month ago.

I think they should certainly monitor blood pressures and neuro function closely, but they should be doing that anyway. From what you've described, I don't think there's anything beyond the standard and necessary that should be done.

Expert:  drcaplan replied 1 month ago.

No, anemia would not compromise oxygen deliver to such a drastic extent. The BP should not be adjusted based on anemia.

Expert:  drcaplan replied 1 month ago.

I don't know that it's fair to call 70 SBP "hypotensive" in a diagnostic or risk factor sense. That is still within the realm of normal limits... although surely on the low side, and not surprising with spinal surgery.

Customer: replied 1 month ago.
That is interesting because my husband had 6 surgeries in 2 years and this was the only surgery that resulted in a sustained hypotensive event and a catastrophic outcome. His BP for these prior surgeries was always maintained at SBP above 100 mmHg. and the MAP was always above 60. I read the chart and have a healthcare background. I also read that systemic hypotensive events during spinal surgery i.e. MAP below 60, can result in complete spinal cord ischemic and flaccid paralysis. I was just curious of what you thought and thanks for answering this question to the best of your ability. By the way my husband was given 3 units of blood, had an EBL of 800 and 2500 of crystalloid. I am just trying to better understand the outcome of the surgery. thanks.
Expert:  drcaplan replied 1 month ago.

I see. It's great that you're reading up and care so much! That is where the best outcomes arise. I think there are some substantial unknowns about the surgery, as I've outlined regarding the appropriate use of BP cuffs and the duration of verified SBPs at 70, and the actual implications of what was operated upon. There are a number of ways that blood pressure can be effected by the surgery of the spinal cord itself. Autonomic dysreflexia can be incurred by surgeons as well as a result of hypotension.

Expert:  drcaplan replied 1 month ago.

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