Supine to sitting under anaesthesia: clinical implications

Here is cardiovascular (CVS) physiology part 2 classified

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Effect of standing due to hydrostatic pressure

 Compensation is Global

-       Baroreceptor

o   A reduction in mean arterial pressure is sensed by the baroreceptors. They decrease their rate of firing which results in an increase in SNS discharge and decreased PNS discharge causing:

o   increased HR

o   increased myocardial contractility ® increased CO ® increased MAP

o   peripheral vasoconstriction ® increased TPR ® increased MAP (greater effect on resistance vessels than on capacitance vessels)

o   venoconstriction ® increased venous return ® increased CO

-       Atrial stretch

o   Over an extended period of time, decreased blood volume will be sensed by the cardiopulmonary receptors as decreased stretch and decreased firing of the A and B receptors will stimulate:

o   release of angiotensin, aldosterone and ADH (­ Na+/H2O reabsorption, restoration of blood volume)

o   increased SNS activity in the kidney (vasoconstriction, ¯ GFR and ¯ urine flow)

-       Venous flow 

o   Skeletal muscle pump

o   Valves

o   Thoracic pump

-       Microcirculation changes

Local 

-       Cerebral autoregulaton 

-       Myogenic mechanism

-       Metabolic 

-       Increase O2 extraction 

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