What is the treatment for postoperative hypotension?

From the Guidelines

Postoperative hypotension should be treated immediately, with the treatment based on the presumed underlying cause, including vasodilation, hypovolaemia, bradycardia, and low cardiac output.

Treatment Approach

• A bedside assessment should be performed to define the cause of hypotension and treat accordingly 1.
• A passive leg raise (PLR) test can be used to assess fluid responsiveness, with an increase in cardiac output after PLR strongly predicting fluid responsiveness 1.
• If the PLR test is positive, intravenous fluid would be appropriate in many instances, while vasopressor or inotropic support is indicated if preload augmentation is not needed 1.
• The choice of vasopressor should take into account the side-effect profile, with phenylephrine best used in situations where hypotension is accompanied by tachycardia 1.

Key Considerations

• Postoperative hypotension is often unrecognized and may be more important than intraoperative hypotension due to its prolonged nature 1.
• The treatment of hypotension should be based on the underlying cause, with a focus on correcting the root cause of the hypotension 1.
• Continuous intraoperative arterial pressure monitoring can help reduce the severity and duration of hypotension compared to intermittent arterial pressure monitoring 1.
• Further research is needed to investigate patient-specific and organ-specific harm thresholds for hypotension and optimal therapies 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 in the postoperative period 2.
• Fluid administration is also a key component of treatment, with the goal of maintaining optimal fluid balance and preventing hypovolemia 3.
• The choice of vasopressor and fluid management strategy may depend on the underlying cause of the hypotension, as well as the patient's individual clinical characteristics and comorbidities.

Use of Vasopressors

The use of vasopressors to treat postoperative hypotension is a common practice, although the evidence supporting their use is limited 2.

• Norepinephrine is a commonly used vasopressor in the postoperative period, due to its potent vasoconstrictive effects 2, 4.
• Other vasopressors, such as phenylephrine and ephedrine, may also be used in certain clinical situations 4.

Fluid Management

Fluid management is critical in the treatment of postoperative hypotension, as hypovolemia can exacerbate hypotension and worsen outcomes 3, 5.

• Goal-directed fluid therapy may be used to optimize fluid balance and maintain adequate perfusion of vital organs 3.
• The type and amount of fluid administered will depend on the patient's individual clinical characteristics and the underlying cause of the hypotension.

Monitoring and Assessment

Close monitoring and assessment of the patient's hemodynamic status is essential in the treatment of postoperative hypotension 5, 6.

• Mean arterial pressure (MAP) is a commonly used metric to assess the adequacy of blood pressure and perfusion of vital organs 5.
• Other hemodynamic parameters, such as cardiac output and systemic vascular resistance, may also be monitored to guide treatment decisions.