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Hypovolemia, the most common cause of hypotension in the early postoperative period, results from inadequate replacement of intraoperative fluid losses, inordinate bleeding, or internal losses of fluid such as rcaccumulation of ascites or third-space losses. Third-space losses represent intravascular fluid losses caused by tissue edema, especially in the operative sile. After abdominal surgery, con¬siderable intraperitoneal hemorrhage can occur, although it may pro¬duce relatively few physical findings. The usual lest for such occult hemorrhage is to administer large amounts of blood or fluids; if blood pressure immediately rises to normal levels, followed by a rapid recur¬rence of hypotension, abdominal recxploration for bleeding is usually indicated.
The patient’s course during the operation must be reviewed, noting the anesthetics used, the estimated fluid loss, and the fluid replace¬ment. The patient’s respiratory status must be assessed as well. If the endotracheal tube is still in place, the chest is examined to make sure i he tube has not blocked a main stem bronchus or a pneumothorax has not developed. If the tube has been removed, the rate and depth of res¬pirations must be determined because reintubation may be necessary.
Drains and catheters should be examined for escaping blood.

Tags: Hypotension

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