From the Guidelines
Postoperative hypotension should be treated when systolic arterial pressure is <90 mm Hg, as this is associated with increased risk of harm.
Treatment of Postoperative Hypotension
- The treatment of postoperative hypotension is based on the presumed underlying cause, and vasopressors or inotropes may be used 1.
- Identifying patient-specific and organ-specific hypotension harm thresholds is crucial, and research is needed to guide monitoring and management strategies for recognizing, preventing, and treating postoperative hypotension 1.
- Continuous intraoperative arterial pressure monitoring can help reduce the severity and duration of hypotension compared to intermittent arterial pressure monitoring 1.
- Postoperative blood pressure regulation is complex, and factors such as patient, procedure, and perioperative care can affect it 1.
- A systolic pressure <90 mm Hg or <30% below baseline is likely to put most patients at risk of end-organ injury, and the risk of harm increases with the duration of hypotension 1.
- The optimal strategy to achieve blood pressure targets is yet to be definitively shown, and research is needed to determine the best method and timing of postoperative blood pressure measurement, including the use of continuous monitoring with wearable devices 1.
- The optimal treatment strategy for postoperative hypotension is not yet known, and research is needed to define the optimal targets for blood pressure and how these are achieved 1.
From the Research
Treatment for Postoperative Hypotension
The treatment for postoperative hypotension typically involves the use of vasopressors and fluids to maintain adequate blood pressure and perfusion of vital organs.
- Vasopressors, such as norepinephrine, are commonly used to treat hypotension 2, 3.
- Fluid administration is also a key component of treatment, with the goal of maintaining adequate fluid balance and preventing hypovolemia 4, 5.
Use of Vasopressors
The use of vasopressors to treat postoperative hypotension is a common practice, but the evidence supporting their use is limited 2.
- A systematic review of 24 studies found that the median proportion of patients receiving vasopressors was 42% 2.
- Norepinephrine was the most common vasopressor used in these studies 2, 3.
Monitoring and Management
Monitoring of blood pressure and other vital signs is crucial in the management of postoperative hypotension.
- The definition of hypotension can vary, but a mean arterial pressure (MAP) of <65 mmHg is often used as a threshold 4, 5.
- Individualized thresholds should be determined based on the patient's preoperative blood pressure and risk profile 5.
Potential Complications
Postoperative hypotension can lead to a range of complications, including: