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Review
. 2020 Feb;64(2):90-96.
doi: 10.4103/ija.IJA_939_19. Epub 2020 Feb 4.

Intraoperative hypotension: Pathophysiology, clinical relevance, and therapeutic approaches

Karim Kouz  1 , Phillip Hoppe  1 , Luisa Briesenick  1 , Bernd Saugel  1   2
Affiliations
Review

Intraoperative hypotension: Pathophysiology, clinical relevance, and therapeutic approaches

Karim Kouz et al. Indian J Anaesth. 2020 Feb.

Abstract

Intraoperative hypotension (IOH) i.e., low arterial blood pressure (AP) during surgery is common in patients having non-cardiac surgery under general anaesthesia. It has a multifactorial aetiology, and is associated with major postoperative complications including acute kidney injury, myocardial injury and death. Therefore, IOH may be a modifiable risk factor for postoperative complications. However, there is no uniform definition for IOH. IOH not only occurs during surgery but also after the induction of general anaesthesia before surgical incision. However, the optimal therapeutic approach to IOH remains elusive. There is evidence from one small randomised controlled trial that individualising AP targets may reduce the risk of postoperative organ dysfunction compared with standard care. More research is needed to define individual AP harm thresholds, to develop therapeutic strategies to treat and avoid IOH, and to integrate new technologies for continuous AP monitoring.

Keywords: Acute kidney injury; blood pressure; haemodynamic monitoring; myocardial injury after non-cardiac surgery; postoperative complications.

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Conflict of interest statement

KK has no conflicts of interest to declare. PH has no conflicts of interest to declare. LB has no conflicts of interest to declare. BS has received honoraria for consulting, honoraria for giving lectures, and refunds of travel expenses from Edwards Lifesciences Inc. (Irvine, CA, USA). BS has received honoraria for consulting, institutional restricted research grants, honoraria for giving lectures, and refunds of travel expenses from Pulsion Medical Systems SE (Feldkirchen, Germany). BS has received institutional restricted research grants, honoraria for giving lectures, and refunds of travel expenses from CNSystems Medizintechnik GmbH (Graz, Austria). BS has received institutional restricted research grants from Retia Medical LLC. (Valhalla, NY, USA). BS has received honoraria for giving lectures from Philips Medizin Systeme Böblingen GmbH (Böblingen, Germany). BS has received honoraria for consulting, institutional restricted research grants, and refunds of travel expenses from Tensys Medical Inc. (San Diego, CA, USA).

Figures

Figure 1
Figure 1
This figure illustrates that a retrospective database study can only provide insights into the association between an exposure (e.g., intraoperative hypotension) and an outcome. In contrast, a randomised controlled trial can provide evidence for a causal relation between the exposure (that is modified by an intervention) and an endpoint
See this image and copyright information in PMC

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