Table 2. Standardized treatment of perioperative hypotension according to a standardized hemodynamic protocol.

Give fluid bolus with 500 mL crystalloid

Repeat 500 mL crystalloid bolus

Lower the epidural rate from 8 to 6 mL/h

Check if there is a significant change in Hct from postoperative level, initiate phenylephrine and titrate to maximum 30 mcg/kg/min

Staff review of the patient, by a surgeon or surgical chief resident

Bolus 500 mL crystalloid over 30 minutes

Repeat staff review if required

Lower the epidural rate from 6 to 4 mL/h

Titrate phenylephrine dose to 60 mcg/kg/min as required

Repeat staff review if required

Each step is sequential, and progressing through the protocol steps requires the patient to continue to demonstrate MAP <70 mmHg.