Intraoperative hypotension: Killing them softly-Hemodynamic Instability and Intraoperative Hypotension (IOH) Infographic

Hemodynamic Instability and Intraoperative Hypotension (IOH) Infographic

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Intraoperative hypotension (IOH) is a significant clinical concern during surgeries, characterized by reductions in mean arterial pressure (MAP) below 65 mm Hg. Factors contributing to IOH include myocardial depression, external pressure on the heart, vasodilation, hypovolemia, bradycardia, pre-operative medications, and surgical manipulation. These factors lead to hemodynamic instability, presenting challenges in patient management during surgery.<br /><br />The incidence of IOH can vary from 19.3% to 30.9% for MAP under 65 mm Hg, depending on definitions and patient populations. Despite efforts to mitigate IOH, some interventions might inadvertently cause patient harm. Hence, improving understanding and management through early detection and educated intervention is emphasized.<br /><br />IOH is linked to various postoperative complications such as acute kidney injury (AKI), surgical site infections (SSIs), myocardial injury after non-cardiac surgery (MINS), pneumonia, postoperative cognitive dysfunction, stroke, prolonged ileus, and postoperative nausea and vomiting (PONV). Factors influencing adverse outcomes from IOH include the severity and duration of hypotension, along with blood pressure variability and advanced patient age.<br /><br />The need for refined approaches to manage hemodynamic stability during surgery is highlighted in literature and healthcare recommendations. The focus is on goal-directed hemodynamic management, which spots the need for timely detection and appropriate interventions to minimize complications. Enhanced education for healthcare providers on the pathophysiology of IOH and awareness of its implications can contribute significantly to improving patient outcomes.<br /><br />A wide range of studies and expert consensus have informed these insights, demonstrating the critical nature of addressing IOH effectively in surgical practice.

Keywords

Intraoperative hypotension

mean arterial pressure

hemodynamic instability

patient management

postoperative complications

goal-directed management

acute kidney injury

myocardial injury

blood pressure variability

surgical practice