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Anesthesia

Low Blood Pressure Due to Condition & Surgery

01/05/2010

Question:

My boyfriend is a war veteran, and has a piece of shrapnel in his abdomen that has broken into several pieces. One has lodged in his kidney and is causing internal bleeding. He is on medication to increase his blood pressure in order to surgically remove the pieces, but the surgeon is afraid his blood pressure won`t be high enough for the date chosen. The last time he had it measured it was 60/40. My questions: 1) What is the minimum blood pressure required for surgery? and 2) How long do you think it would take for it to rise to the minimum level?

Answer:

In an adult, a blood pressure of 60/40 is very low indeed. Perhaps you've not understood the correct number. If your boyfriend's blood pressure is in fact this low then he is critically ill. A patient like this may have ongoing bleeding or may have developed sepsis, which is part of the body's response to massive trauma, with or without infection. The blood pressure would indeed have to be increased, with drugs and fluids or blood, before a patient like this is stable enough to tolerate anesthesia and surgery. There is no absolute number of blood pressure, rather the decision making depends on assessing all the factors, including the benefit of removing the shrapnel and, more importantly, of repairing whatever injuries have been caused by it. A systolic (upper) blood pressure of 90 to 100 is closer to what might be considered acceptable under these circumstances.

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Response by:

Gareth S Kantor, MD Gareth S Kantor, MD
Assistant Professor of Anesthesiology
School of Medicine
Case Western Reserve University