my guess if that they question that is being asked is that if you are trying to be fluid conservative in the OR how does one deal with hypotension related to ACE-I.
2 separate questions in my opinion.
1. Fluid conservation- a matter of what type of surgery in what situation. The research in this area is not complete by any means. All the permutations have not been studied. But i do believe that the old empiric dosing of fluid administration during procedure is indeed outdated. I believe the literature supports fluid administration based on procedure type, with more emphasis on real time data feedback and not just using predetermined estimates. IE Bowel surgery patients do better with a limited approach to fluids, using boluses for low BP combined with low UOP. Data would suggest longer return of bowel function more dehiscence or breakdown of anastomosis with large fluid administration. IN Out PT anesthesia for a Gallbladder or hernia data would suggest that a larger fluid administration patients have better lung function less PONV, less Pain, and a better overall feeling after surgery. Regardless Euvolumia is the goal it just matters on which end of it you are. IN the end give the patient what they need when they need it.
2. Intraoperative Hypotension- Not all hypotension in the OR is hypovolemia!! Reciprocally not all hypotension in the OR is a result of vasodilation. If the BP is supported, your patients should not have an ischemic events from low flow unless they are severely hypovolemic. When you say a "fair amount' how much are you talking? How much Anesthesia are you delivering and it what form (GA only, GA with regional), sitting positon, supine etc. These questions are what we get paid by the patients to determine. IF the patient had a normal BP and HR in preop and only became Hypotensive during Anesthesia and there has been no blood loss, then am going to guess that my anesthetics are causing a problem and would be more comfortable with pressors to counteract ACEI issues.
or is it a floor policy.
