Intraoperative hypotension: Killing them softly-Intraoperative hypotension: Killing them softly

Video Transcription

Video Summary

In a presentation led by Desiree Chappell and Amy Yurden, CRNAs with extensive anesthesia experience, the session focused on intraoperative hypotension (IOH) and its implications on patient outcomes during surgery. IOH, defined as a mean arterial pressure (MAP) below 65 mmHg, is known to lead to negative outcomes such as acute kidney injury and myocardial injury. The session emphasized the importance of not just treating the numeric hypotension with vasopressors like phenylephrine but addressing the root causes such as hypovolemia and myocardial depression. They advocated for a systematic, data-driven approach using advanced hemodynamic monitoring. The speakers encouraged filling the blood volume first, assessing flow (cardiac output), and using pressors only if needed. Highlighted studies showed the impact of inadequate management, pointing out complications even with low-dose vasopressors like norepinephrine, advocating for choice based on individual patient dynamics rather than a uniform protocol. The discussion pointed to ongoing research on continuous blood pressure monitoring, and the potential role of AI in anesthesia, stressing adapting clinical practices to new evidence for better patient outcomes. Addressing the skepticism from some surgical teams, presenters suggested using current literature to argue for evidence-based changes in anesthesia management, specifically on fluid management and hemodynamic stability. The presentation concluded with a reminder of the broader implications of IOH and offered practical insights for clinicians to potentially improve patient care by integrating proven techniques and emerging technologies in their practice.

Keywords

intraoperative hypotension

anesthesia

patient outcomes

mean arterial pressure

hemodynamic monitoring

vasopressors

fluid management

continuous blood pressure monitoring

AI in anesthesia

evidence-based practice