Choice
- Spinal anaesthesia is traditionally avoided:
- Potential for hypotension and vasodilation caused by the rapid onset of sympathetic blockade
- Decreased preload and decrease in cardiac output
- Decrease in afterload and coronary filling
- Cases of carefully titrated anaesthesia using spinal or epidural catheter reported
- Limb blocks may be beneficial, either alone or as an adjunct to general anaesthesia.
Induction & Maintenance
- Extreme care needs to be taken with induction of anaesthesia to avoid hypotension:
- Titrate all anaesthetic drugs very carefully
- Options include high dose opioids and etomidate or inhalational induction
- Use vasopressors to maintain pre-induction blood pressure-levels:
- Ensure vasopressor drugs (phenylephrine or metaraminol) at hand
- Infusions running peripheral vasopressor during induction facilitate maintenance of pressure