Intraoperative hypotension: Pathophysiology, clinical relevance, and therapeutic approaches

• Published in: Indian journal of anaesthesia Vol. 64; no. 2; pp. 90 - 96
• Main Authors: Kouz, Karim, Hoppe, Phillip, Briesenick, Luisa, Saugel, Bernd
• Format: Journal Article
• Language: English
• Published: India Wolters Kluwer India Pvt. Ltd 01.02.2020; Medknow Publications and Media Pvt. Ltd; Medknow Publications & Media Pvt. Ltd; Wolters Kluwer - Medknow; Wolters Kluwer Medknow Publications
• Subjects: acute kidney injury; Anesthesia; Angiotensin II; Blood pressure; Cardiac patients; Death; haemodynamic monitoring; Health aspects; Hospital patients; Mortality; myocardial injury after non-cardiac surgery; Patients; Postoperative complications; Review; Studies; postoperative complications; blood pressure; haemodynamic monitoring; myocardial injury after non-cardiac surgery; Acute kidney injury
• ISSN: 0019-5049; 0976-2817
• DOI: 10.4103/ija.IJA_939_19

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.