Intraoperative Hemodynamics: Additional Resources-Intraoperative Hypotension Pathophysiology and Adverse Effects Slide Deck

Intraoperative Hypotension Pathophysiology and Adverse Effects Slide Deck

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This document provides a comprehensive review of intraoperative hypotension (IOH), a prevalent and clinically significant concern in anesthesiology during surgery. Authored by Rhea Temmermand, it is aimed at nurse anesthesiologists and emphasizes the importance of understanding both the mechanisms and consequences of IOH to enhance patient outcomes and mitigate postoperative complications.

IOH is defined as a mean arterial pressure (MAP) below 65 mmHg for at least one minute or a relative reduction of 20-30% from baseline. Approximately 88% of patients undergoing non-cardiac surgeries experience at least one hypotensive episode, averaging 28.2 minutes. IOH is independently linked to increased risks of complications like myocardial injury, acute kidney injury (AKI), and death.

The document outlines the pathophysiological mechanisms of IOH such as anesthetic-induced vasodilation, hypovolemia, low cardiac output, impaired autonomic regulation, and mechanical factors. It also explains molecular mechanisms, including increased nitric oxide production and associated impacts on cardiac function.

The multi-system adverse effects of IOH are detailed: 
- <strong>Cardiac Effects</strong>: Reduced coronary perfusion can lead to myocardial ischemia, infarction, and arrhythmias.
- <strong>Renal Effects</strong>: IOH risks compromising glomerular filtration and renal perfusion, causing AKI due to oxidative stress, inflammation, and tubular damage.
- <strong>Neurological Effects</strong>: Cerebral hypoperfusion raises the potential for perioperative stroke, cognitive dysfunction, and delirium.
- <strong>Gastrointestinal Effects</strong>: Reduced splanchnic blood flow leads to mucosal ischemia, increased gut permeability, and potential postoperative ileus.

Overall, the document stresses the intricate relationship between hypotension and organ dysfunction during and post-surgery, underscoring the importance of blood pressure management in surgical settings.

Keywords

intraoperative hypotension

anesthesiology

nurse anesthesiologists

mean arterial pressure

myocardial injury

acute kidney injury

vasodilation

cerebral hypoperfusion

blood pressure management

postoperative complications