Management of Intraoperative Hypotension: Prediction, Prevention and Personalization
The human cardiovascular system is pressure regulated with relatively high arterial pressures to guarantee organ perfusion. Arterial blood pressure is kept fairly constant, at least in healthy individuals. The system can be compared to a water tower providing a constant pressure head, with changes in local resistance (like opening the water tap), allowing a distribution of flow to the different organs, according to their need. Some organ systems (e.g., the brain and kidneys) regulate blood flow – within certain limits – independently of blood pressure. This phenomenon is called ‘autoregulation of blood flow’ and aims at protecting these organs from hypoperfusion. Below the lower limits of this autoregulation, organ perfusion becomes linearly dependent on blood pressure. Even in some circulatory shock states (hypovolemic shock and cardiogenic shock), blood pressure is kept constant for a long time due to stimulation of the sympathetic nervous system,...
- 1.Bijker JB, van Klei WA, Kappen TH, van Wolfswinkel L, Moons KG, Kalkman CJ (2007) Incidence of intraoperative hypotension as a function of the chosen definition: literature definitions applied to a retrospective cohort using automated data collection. Anesthesiology 107:213–220CrossRefGoogle Scholar
- 9.Salmasi V, Maheshwari K, Yang D et al (2017) Relationship between intraoperative hypotension, defined by either reduction from baseline or absolute thresholds, and acute kidney and myocardial injury after noncardiac surgery: a retrospective cohort analysis. Anesthesiology 126:47–65CrossRefGoogle Scholar