Intraoperative Mean Arterial Pressure Variability and 30-day Mortality in Patients Having Noncardiac Surgery

Abstract

Although lower mean arterial pressure is strongly associated with mortality, lower intraoperative blood pressure variability per se is only mildly associated with postoperative mortality after noncardiac surgery.

Association of intra‐operative hypotension with acute kidney injury, myocardial injury and mortality in non‐cardiac surgery: A meta‐analysis

“…Three studies investigated the effect of IOH (presented as MAP absolute level) on postoperative 30‐day mortality, and IOH was defined as MAP < 60 mm Hg. An intra‐operative MAP < 60 mm Hg for 1‐5 minutes was not associated with postoperative 30‐day mortality [OR = 1.15, 95% CI (0.95, 1.4), I 2 = 0, Z = 1.43, P = .154], but an intra‐operative MAP < 60 mm Hg for more than 5 minutes was associated with an increased risk of postoperative 30‐day mortality [OR = 1.11, 95% CI (1.06, 1.17), I 2 = 51.9%, Z = 4.28, P < .0001].…”

Expansion volémique ou noradrénaline : que choisir ?

“…Il est possible que des durées cumulées d'hTPA soient interprétées comme un signal de danger à travers l'hypoxie tissulaire [19] mettant en jeu de multiples mécanismes compensateurs dont l'activation du système nerveux sympathique et la réaction inflammatoire avec des conséquences délétères. Les variations (hypo-et hypertension artérielle) de la pression artérielle, même relativement mineures, pourraient représenter des successions d'épisodes d'ischémie-reperfusion [2,20].…”

Good intra‐operative anaesthesia is more than an ‘airway, breathing, circulation, drugs with a three, two and a one’

“…The ABCD mnemonic is a useful aide memoire. However, contemporary studies have demonstrated that the presence of an ABC is not always sufficient to prevent end‐organ dysfunction, as among other clinical variables, hypotension, tachycardia and dysglycaemia are associated with poor outcome . This concept is also in line with the aviation checklist proposed by Jelacic et al., as they advocate the necessity of agreeing blood pressure and heart rate goals before commencement of anaesthesia .…”