Anaesthetists Handbook - MEDICAL EDUCATION at University ...

Epidural anaesthesia and analgesiathe risk of venous thrombosis. Hypotension secondary tovasodilatation usually responds to an increase in intravenous fluids.Risks• Prolonged hypotension may place newly formed anastomosesat risk of ischaemia• In some patient excess intravenous fluid replacement may leadto pulmonary oedema.IT IS NOT THE ROLE OF THE ACUTE PAIN TEAM TO INFLUENCETHE FLUID MANAGEMENT OF SURGICAL PATIENTSManagement options1. Exclude all other causes of hypotension (e.g. haemorrhage,myocardial infarction) and check block height is not at T4 orabove.2. Administer IV fluids – this will usually be an initial bolus of200 mL of maintenance fluid or a plasma expander asprescribed.3. Consider use of a metaraminol infusion (see separateguidelines).4. In some circumstances it may be necessary to stop or reducethe epidural infusion. This should only be done followinganaesthetic or pain team review.If the blood pressure fails to respond to the measures above or thereis more urgent cause for concern seek immediate surgical andanaesthetic review.Using metaraminol infusionsThese may be used on the enhanced care unit on ward 22, withepidural analgesia after elective surgery.130 Anaesthetists Handbook January 2010