Blood pressure measurements during intraoperative pediatric scoliosis surgery
Lisgelia Santana1, Gary M Kiebzak2, Nikia Toomey3
1Department of Anesthesiology and Pain Management, Nemours Children's Hospital, Orlando, Florida, USA.
Insights
Intraoperative hypotension in pediatric scoliosis surgery is common, with no clear definition. Mean arterial pressure below 60 mmHg may be a better indicator for intervention, correlating with vasopressor use and showing no adverse outcomes.
Area of Science:
- Anesthesiology
- Pediatric Orthopedics
- Surgical Outcomes
Background:
- Intraoperative hypotension is a frequent surgical complication linked to adverse outcomes.
- Current standards for defining and managing intraoperative hypotension lack universal agreement.
- Effective blood pressure monitoring is crucial but lacks standardized interpretation guidelines.
Purpose of the Study:
- To retrospectively evaluate definitions of intraoperative hypotension in pediatric idiopathic scoliosis surgery.
- To correlate hypotension definitions with vasopressor use and patient outcomes.
- To propose a refined definition for intraoperative hypotension in this patient population.
Main Methods:
- Retrospective chart review of 70 pediatric patients undergoing idiopathic scoliosis surgery.
- Arterial line used for continuous blood pressure monitoring.
- Hypotension defined as 20% or 30% decrease in systolic blood pressure (SBP) or mean arterial pressure (MAP) < 60 mmHg.
Main Results:
- A significant correlation was found between the three hypotension measures.
- Sixty percent of patients received vasopressors, with a significant link between MAP < 60 mmHg and ephedrine use.
- No changes in neuromonitoring or intraoperative/postoperative complications were observed.
Conclusions:
- While tight blood pressure control is desired to minimize blood loss, a precise definition of hypotension remains elusive.
- Mean arterial pressure < 60 mmHg is proposed as a potentially superior definition for intraoperative hypotension.
- Recommendations for future research are provided to establish clearer guidelines.
Background:
Intraoperative hypotension is frequently encountered during surgery and it can be associated with adverse outcomes. Blood pressure monitoring is critical during surgery, but there are no universally agreed upon standards for interpreting values of hypotension and no consensus regarding interventions.
Material And Methods:
We performed a retrospective chart review of pediatric patients who underwent idiopathic scoliosis surgery by a single surgeon. We used the arterial line for all measures. Intraoperative hypotension was defined as 20% decrease of the baseline systolic blood pressure (SBP), 30% decrease of baseline SBP, or mean arterial pressure less than 60 mmHg. Use of vasopressor agents was also recorded and correlated with blood pressure definitions.
Results:
Seventy idiopathic scoliosis patients were retrospectively evaluated. There was a significant correlation between the three measures of hypotension. Sixty percent of the patients received vasopressors. There was a significant correlation between a drop of mean arterial pressure to less than 60 mmHg and the use of the ephedrine. We did not find any changes on neuromonitoring measures during the case and there were no intraoperative or one-month postoperative complications.
Conclusions:
Blood pressure is only one of the measures anesthesiologists look to for good perfusion during surgery. Pediatric anesthesiologists and orthopedics agree in trying tight blood pressure control during surgery to decrease blood loss, but what the exact definition of that blood pressure number is, is still unclear. We propose that using mean arterial pressure less than 60 mmHg is perhaps a better definition. We provide recommendations for future studies.
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