Anesthesia complicated by utilization of controlled hypotension (List separately in addition to code for primary anesthesia procedure)
CPT4 code
Name of the Procedure:
Controlled Hypotensive Anesthesia
Summary
Controlled hypotensive anesthesia is an advanced anesthesia technique where blood pressure is deliberately lowered to minimize bleeding during surgery, enhancing the operative field for better visibility and precision.
Purpose
Controlled hypotensive anesthesia is used to reduce blood loss during surgery, which can make the procedure safer and more efficient. It helps surgeons work more effectively by providing a clearer view of the surgical area.
Indications
This procedure is typically indicated for surgeries where blood loss can be significant, such as orthopedic surgery, neurosurgery, or head and neck surgeries. It’s appropriate for patients undergoing complex and lengthy operations where reducing intraoperative bleeding is beneficial.
Preparation
Patients should follow standard pre-anesthesia instructions, including fasting for at least 8 hours before the procedure. Medications may need to be adjusted, especially blood thinners. Pre-operative assessments, such as blood tests, ECG, and blood pressure monitoring, are performed to ensure the patient is fit for controlled hypotension.
Procedure Description
- The patient is brought to the operating room and connected to monitoring devices to continuously track vital signs.
- The primary anesthesia is administered, often general anesthesia, to ensure the patient is unconscious and pain-free.
- Special medications are then introduced to lower the patient's blood pressure to a controlled level.
- Blood pressure is carefully monitored and adjusted throughout the surgery to maintain the desired level of hypotension.
- Once the surgery is completed, medications are adjusted to gradually bring blood pressure back to normal levels.
Duration
The controlled hypotension phase lasts for the duration of the surgery and can vary from 1 to several hours, depending on the complexity of the procedure.
Setting
The procedure is performed in a hospital or surgical center equipped with advanced anesthesia and monitoring technology.
Personnel
A team typically includes the primary surgeon, an anesthesiologist specialized in controlled hypotensive techniques, surgical nurses, and anesthesiology assistants.
Risks and Complications
- Common risks: Nausea, dizziness upon waking, transient blood pressure drops.
- Rare complications: Prolonged hypotension, organ hypoperfusion, adverse reactions to hypotensive drugs.
- Management of complications involves immediate intervention with fluids, medications, or other supportive measures to stabilize blood pressure.
Benefits
- Reduced blood loss during surgery.
- Improved visibility and accuracy for the surgeon.
- Potentially shorter operative time and improved outcomes. These benefits are often realized immediately during surgery.
Recovery
Post-procedure care includes monitoring in a recovery room until the patient’s vitals stabilize. Pain management, hydration, and gradual reintroduction to eating and drinking are provided. Most patients can expect to resume normal activities within a few days to a week, depending on the surgery’s nature.
Alternatives
Alternative options may include using conventional anesthesia without controlled hypotension, which might result in greater intraoperative blood loss. The pros and cons of these alternatives include simpler anesthesia management but potentially more challenging surgical conditions and longer recovery times due to increased blood loss.
Patient Experience
Patients will be unconscious during the procedure and should not feel pain. Post-procedure, they might experience some dizziness or nausea as their blood pressure stabilizes. Pain management and comfort measures, such as anti-nausea medication, are routinely provided to ensure a smooth recovery.