Newly Published
Perioperative Medicine  |   January 2019
Incidence, Severity, and Detection of Blood Pressure Perturbations after Abdominal Surgery: A Prospective Blinded Observational Study
Author Notes
  • From the Departments of Outcomes Research (A.T., C.C., B.C., W.S., H.E., K.H., A.K.K., J.V., K.R., K.M., D.I.S.) and General Anesthesia (A.T., A.K.K., A.S., K.R., K.M.) and the Center for Critical Care (A.K.K.), Anesthesiology Institute, and the Department of Quantitative Health Sciences (D.Y., C.M.), Cleveland Clinic, Cleveland, Ohio; the Division of Anesthesia, Critical Care and Pain Management, Tel Aviv Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (B.C.); and the Department of Anesthesiology, Detroit Medical Center, Detroit, Michigan (W.S.).
  • Submitted for publication June 7, 2018. Accepted for publication December 18, 2018.
    Submitted for publication June 7, 2018. Accepted for publication December 18, 2018.×
  • Correspondence: Address correspondence to Dr. Turan: Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, 9500 Euclid Avenue, P-77, Cleveland, Ohio 44195. turana@ccf.org. Information on purchasing reprints may be found at www.anesthesiology.org or on the masthead page at the beginning of this issue. Anesthesiology’s articles are made freely accessible to all readers, for personal use only, 6 months from the cover date of the issue.
Article Information
Perioperative Medicine / Cardiovascular Anesthesia / Respiratory System
Perioperative Medicine   |   January 2019
Incidence, Severity, and Detection of Blood Pressure Perturbations after Abdominal Surgery: A Prospective Blinded Observational Study
Anesthesiology Newly Published on January 31, 2019. doi:10.1097/ALN.0000000000002626
Anesthesiology Newly Published on January 31, 2019. doi:10.1097/ALN.0000000000002626
Abstract

Editor’s Perspective:

What We Already Know about This Topic:

  • Intraoperative and postoperative hypotension are associated with myocardial and kidney injury and 30-day mortality

  • Intraoperative blood pressure is measured frequently, but blood pressure on surgical wards is usually measured only every 4 to 6 h

What This Article Tells Us That Is New:

  • In adults recovering from abdominal surgery, continuous blood pressure recording with a noninvasive monitor revealed that both hypotension and hypertension were common, prolonged, and profound

  • Many of these events were not detected by the routine intermittent vital-sign assessments at 4-h intervals

Background: Intraoperative and postoperative hypotension are associated with myocardial and kidney injury and 30-day mortality. Intraoperative blood pressure is measured frequently, but blood pressure on surgical wards is usually measured only every 4 to 6 h, leaving long intervals during which hypotension and hypertension may be undetected. This study evaluated the incidence and severity of postoperative hypotension and hypertension in adults recovering from abdominal surgery and the extent to which serious perturbations were missed by routine vital-sign assessments.

Methods: Blood pressure was recorded at 1-min intervals during the initial 48 h in adults recovering from abdominal surgery using a continuous noninvasive monitor. Caregivers were blinded to these measurements and depended on routine vital-sign assessments. Hypotension and hypertension were characterized as time under and above various mean arterial pressure thresholds.

Results: Of 502 available patients, 312 patients with high-quality records were analyzed, with a median measurement time of 48 [interquartile range: 41, 48] postoperative hours. Nearly a quarter experienced an episode of mean arterial pressure of less than 70 mm Hg lasting at least 30 min (24%; 95% CI, 20%, 29%), and 18% had an episode of mean arterial pressure of less than 65 mm Hg lasting at least 15 min. Nearly half the patients who had mean arterial pressure of less than 65 mm Hg for at least 15 min (47%; 95% CI, 34%, 61%) were undetected by routine vital-sign assessments. Episodes of mean arterial pressure greater than 110 mm Hg lasting at least 30 min were observed in 42% (95% CI, 37%, 48%) of patients; 7% had mean arterial pressure greater than 130 mm Hg for at least 30 min, 96% of which were missed by routine assessments. Episodes of mean arterial pressure less than 65 mm Hg and mean arterial pressure greater than 110 mm Hg captured by routine vital-sign assessments but not by continuous monitoring occurred in 34 and 8 patients, respectively.

Conclusions: Postoperative hypotension and hypertension were common, prolonged, profound, and largely undetected by routine vital-sign assessments in a cohort of adults recovering from abdominal surgery. Frequent or continuous blood pressure monitoring may detect hemodynamic perturbations more effectively and potentially facilitate treatment.