Provisional Decision-Making for Perioperative Blood Pressure Management: A Narrative Review

Abstract

Blood pressure (BP) is a basic determinant for organ blood flow supply. Insufficient blood supply will cause tissue hypoxia, provoke cellular oxidative stress, and to some extent lead to organ injury. Perioperative BP is labile and dynamic, and intraoperative hypotension is common. It is unclear whether there is a causal relationship between intraoperative hypotension and organ injury. However, hypotension surely compromises perfusion and causes harm to some extent. Because the harm threshold remains unknown, various guidelines for intraoperative BP management have been proposed. With the pending definitions from robust randomized trials, it is reasonable to consider observational analyses suggesting that mean arterial pressures below 65 mmHg sustained for more than 15 minutes are associated with myocardial and renal injury. Advances in machine learning and artificial intelligence may facilitate the management of hemodynamics globally, including fluid administration, rather than BP alone. The previous mounting studies concentrated on associations between BP targets and adverse complications, whereas few studies were concerned about how to treat and multiple factors for decision-making. Hence, in this narrative review, we discussed the way of BP measurement and current knowledge about baseline BP extracting for surgical patients, highlighted the decision-making process for BP management with a view to providing pragmatic guidance for BP treatment in the clinical settings, and evaluated the merits of an automated blood control system in predicting hypotension.

Protocol for development and validation of a prediction model for post-induction hypotension in elderly patients undergoing non-cardiac surgery: a prospective cohort study

“…In our study, we set the measurement interval at every 1 min for a total duration of 15 min or before skin incision, which improves the ability to detect PIH. In addition, the baseline MAP values will be determined in the ward preoperatively to avoid possible impact by anxiety after entering the operating room 34. Although several PIH prediction models incorporating machine learning have been reported,11–13 their data were retrospectively collected with a limited number of patients.…”

Optimizing nicardipine dosage for effective control of pituitrin-induced hypertension in laparoscopic myomectomy undergoing total intravenous anesthesia

“…Electrocardiography (ECG), invasive arterial blood pressure, heart rate (HR), peripheral oxygen saturation (SpO 2 ), and bispectral index (BIS) values were recorded. Baseline blood pressure was measured in a calm state before anesthesia administration in the ward [ 18 , 19 ].…”

Optimizing Nicardipine Dosage for Effective Control of Pituitrin-Induced Hypertension in Laparoscopic Myomectomy Undergoing Total Intravenous Anesthesia

“…Electrocardiography (ECG), invasive arterial blood pressure, heart rate (HR), peripheral oxygen saturation (SpO 2 ), and bispectral index (BIS) values were recorded. Baseline blood pressure was measured in a calm state before anesthesia administration in the ward [19,20].…”