POTS&anaesthesia
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DrRogerCorderyConsultantinCardiothoracicAnaesthesiaandCri;calCare
POTS&anaesthesia
» 0.2%popula;on» Rare,under-recognisedbycliniciansandprobablyunder-diagnosed
» Someimportantassocia;onsforanaesthe;sts» Chronicfa;gue» Ehlers-Danlos» Mitralvalveprolapse» Inflammatoryboweldisease
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Pathophysiology
» Peripheralautonomicdenerva;on» Hypovolaemia» Decondi;oning(↓SV,↓LVmass)» Anxietyandhyper-vigilance
» HyperadrenergicPOTS
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Anaesthesia
» Autonomicchanges
» Significantvasodila;on
» Moresowithregionalanaesthesia
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Anaesthesia
» Posi;vepressureven;la;on» Surgicalissues» Bloodloss» Pneumoperitoneum» Posi;on
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Evidencebase
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Pre-opera;veassessment
» Iden;fica;onofpa;ents» Increasedawarenessamongstcliniciansofimplica;ons
» Triggerfactors» Associatedsyndromes» POTStreatment
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Pharmacology
» Midodrine(pro-drugα1-agonist)
» Fludrocor;sone» Propranolol» Pyridos;gmine
» Clonidine» Methyldopa
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Intra-opera;vecare
» Caseseries13pa;ents» 3developedprolongedhypotension» Invasivemonitoring?
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Intra-opera;vecare
» Caseseries13pa;ents» 3developedprolongedhypotension» Invasivemonitoring?
» HyperadrenergicPOTS» Exaggeratedhypertensiveresponse» Avoidketamine
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Obstetriccare
» RegionaltechniquespreferredforLSCS» Epiduralanalgesiacommon» RegionaltechniquesinPOTSonlydescribedinobstetrics
» EarlyepiduralinhyperadrenergicPOTS
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Post-opera;vecare
» IdeallydoneincentrewithPOTSphysician» Earlymobilisa;onmaybeproblema;c» Suitabilityfordaycase?» Poten;alfor↑DVTrisk/respiratorycompromise
» Importancetomaintainpre-optherapyifpossible
» Avoiddrugswhichcausetachycardia(e.g.cyclizine)
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Painmanagement
» Chronicfa;gue,hyper-vigilance&anxiety» Issueswithpainmanagement
» Earlymul;-modalapproach
» Regional/neuraxialtechniques» Ehlers-Danlosmayberesistanttolocalanaesthesia
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Summary
» Poten;allydifficultgroup» Uncommonandcanpresentformul;pleinterven;ons
» Notonradarofmostsurgeons/anaesthe;sts&needincreasedawareness
» Shouldhavemul;-disciplinarycare» MaintenanceofpreopRximportant» Painmanagementmaybeproblema;c