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Drugs: Controlled Hypotension

Controlled hypotension is the process of deliberately reducing a patient’s blood pressure (typically, ~30% reduction of baseline MAP) for a therapeutic purpose. This is accomplished by reduction of either SVR or CO.


1. Improve visualization of operative field

2. Reduce hemorrhagic loss and transfusions

3. Decreased amount of cauterized tissue

4. Most frequently used in Neurosurgery, Orthopedics, ENT, and Gynecology


1. Cerebrovascular disease

2. Cardiovascular disease

3. Aortic Stenosis

4. Renal Dysfunction

5. Pregnancy

6. Severe hypovolemia or anemia


1. Reduced end-organ perfusion and tissue oxygenation with tissue damage

2. Resultant acidosis


1. Volatile Anesthetics

2. Direct Vasodilators (Sodium Nitroprusside, Nitroglycerin, Hydralazine)

3. Alpha Blockers (Phentolamine)

4. Beta Blockers (Esmolol, Labetalol)

5. Calcium Channel Blockers (Nicardipine)