Automated Ambulatory Blood Pressure Measurements and Intraoperative Hypotension in Patients Having Noncardiac Surgery with General Anesthesia: A Prospective Observational Study
Editor's Perspective What We Already Know about This Topic Intraoperative hypotension is associated with significant postoperative complications Intraoperative hypotension has been defined relative to preinduction blood pressure Blood pressure varies during the day, and the relationship between preinduction blood pressure and usual blood pressure over 24 h is incompletely described Similarly the relationship between low blood pressure intraoperatively and 24-h usual blood pressure is unknown What This Article Tells Us That Is New There is a poor correlation between preinduction blood pressure and the usual blood pressure over 24 h In two thirds of patients, the lowest postinduction and intraoperative pressures were lower than the lowest nighttime blood pressure Background: Normal blood pressure varies among individuals and over the circadian cycle. Preinduction blood pressure may not be representative of a patient's normal blood pressure profile and cannot give an indication of a patient's usual range of blood pressures. This study therefore aimed to determine the relationship between ambulatory mean arterial pressure and preinduction, postinduction, and intraoperative mean arterial pressures. Methods: Ambulatory (automated oscillometric measurements at 30-min intervals) and preinduction, postinduction, and intraoperative mean arterial pressures (1-min intervals) were prospectively measured and compared in 370 American Society of Anesthesiology physical status classification I or II patients aged 40 to 65 yr having elective noncardiac surgery with general anesthesia. Results: There was only a weak correlation between the first preinduction and mean daytime mean arterial pressure (r = 0.429, P < 0.001). The difference between the first preinduction and mean daytime mean arterial pressure varied considerably among individuals. In about two thirds of the patients, the lowest postinduction and intraoperative mean arterial pressures were lower than the lowest nighttime mean arterial pressure. The difference between the lowest nighttime mean arterial pressure and a mean arterial pressure of 65 mmHg varied considerably among individuals. The lowest nighttime mean arterial pressure was higher than 65 mmHg in 263 patients (71%). Conclusions: Preinduction mean arterial pressure cannot be used as a surrogate for the normal daytime mean arterial pressure. The lowest postinduction and intraoperative mean arterial pressures are lower than the lowest nighttime mean arterial pressure in most patients. © 2019, the American Society of Anesthesiologists, Inc. Wolters Kluwer Health, Inc.