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Table 2 Treatment for hemodynamic disturbances

From: Sevoflurane versus PRopofol combined with Remifentanil anesthesia Impact on postoperative Neurologic function in supratentorial Gliomas (SPRING): protocol for a randomized controlled trial

Hemodynamic FluctuationDefinition
(if any of the below changes are sustained for equal and/or longer than 5 min)
Standard Treatment Algorithm
Hypertension EpisodeMAP > 20% above preoperative baselineIncrease propofol or sevoflurane concentration according to BIS, increase remifentanil infusion rate, or administer 5mcg sufentanil; if correction still not achieved, nicardipine will be given as bolus and/or infusion
Hypotension EpisodeMAP < 20% below preoperative baselineDecrease propofol or sevoflurane concentration according to BIS, give adequate volume loading; if correction still not achieved, vasoactive agent administration (dopamine, norepinephrine, or phenylephrine) will be given with the dose and infusion rate adjusted according to the blood pressure response
Tachycardia
Episode
HR > 100 bpmEsmolol bolus and/or infusion according to heart rate response
Bradycardia
Episode
HR < 45 bpmAtropine administration
  1. MAP mean arterial pressure, HR heart rate, bpm beat per minute