oa South African Medical Journal - Hypotensive anaesthesia in plastic surgery
Hypotensive anaesthesia utilizing Hexamethonium Bromide has proved to be effective in reducing the amount of anaesthetic used. Shock is not a feature and postoperative sickness is minimized. Venous thrombosis, cerebral anaemia, intestinal ileus, renal break-down, or any other complications that may be attributed to autonomic paralysis or very low blood pressure have not been observed. It is felt that these complications can be avoided by correct selection of cases, careful blood pressure readings throughout, full oxygenation, avoidance of prolonged operations and adequate after-treatment. The reduction in bleeding improves surgical accuracy, lessens trauma and buried suture material, shortens operation time and reduces post-operative oedema and bruising to a minimum. The extent of tumour, disease or scar to be removed can be assessed more accurately, and skin-flap viability is more easily gauged. The Methonium compounds used to produce the fall in blood pressure should be used only by skilled anaesthetists. Team work is essential, calling not only for full co-operation between anaesthetist and surgeon but also between the doctors and the nursing staff. Good postoperative care is essential.
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