In recent large retrospective studies, intraoperative hypotension of even 5 minutes’ duration (systolic blood pressure < 70 mm Hg, MAP < 50 mm Hg, diastolic blood pressure < 30 mm Hg) is associated with increased postoperative morbidity and mortality risks. Intraoperative hemodynamic instability has long been thought to result in worse outcomes after surgery. All have typical injury patterns associated with prolonged “shock.” Understanding the physiology behind hypotension is critical for diagnosis and treatment. Organs of most immediate concern are the heart and brain, followed by the kidneys, liver, and lungs. Hypotension can be of sufficient magnitude to jeopardize organ perfusion, causing injury and an adverse outcome. Hypotension varies from mild clinically insignificant reductions in MAP from general anesthesia or regional anesthesia to life-threatening emergencies. Although treatment of chronic systemic hypertension is sometimes necessary, acute hypotension is often a problem with many anesthetics. Systemic arterial blood pressure and mean arterial pressure (MAP) are commonly monitored by anesthesia providers via a blood pressure cuff or an indwelling arterial cannula.
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