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[Intraoperative hypotension in children-Measurement and treatment]
Sebastian Bratke1, Sebastian Schmid2, Vijyant Sabharwal3
1Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinikum Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Deutschland.
Insights
Intraoperative hypotension in pediatric anesthesia requires careful blood pressure monitoring. Key thresholds and prompt interventions using fluids or vasopressors are crucial for managing this common complication.
Area of Science:
- Pediatric Anesthesia
- Perioperative Medicine
- Hemodynamic Monitoring
Context:
- Intraoperative hypotension is a frequent complication in pediatric anesthesia.
- Accurate blood pressure monitoring is vital, with the upper arm being the optimal site for oscillometric measurements.
- Invasive monitoring remains the gold standard for critically ill or major surgery pediatric patients.
Purpose:
- To define optimal blood pressure monitoring strategies and hypotension thresholds in pediatric anesthesia.
- To outline current treatment options for intraoperative hypotension in children.
- To highlight the need for further research on outcome improvements following hypotension management.
Summary:
- Established threshold values for intraoperative hypotension in pediatric patients range from 40 mmHg in newborns to 65 mmHg in adolescents, based on mean arterial pressure.
- Treatment initiation is recommended at a 10% deviation from baseline, with intensification at 20%.
- Treatment options include crystalloid solutions and vasopressors, emphasizing the importance of rapid intervention, though outcome data is limited.
Impact:
- Provides clear, age-specific hypotension thresholds for pediatric anesthesia, aiding clinical decision-making.
- Highlights the importance of correct cuff size and measurement site for noninvasive blood pressure monitoring in children.
- Underscores the critical need for timely intervention in pediatric intraoperative hypotension and identifies areas for future research.
Abstract:
Intraoperative hypotension is a common perioperative complication in pediatric anesthesia. Oscillometric blood pressure measurement is therefore an essential part of standard perioperative monitoring in pediatric anesthesia. The optimum measurement site is the upper arm. Attention must be paid to the correct cuff size. Blood pressure should be measured before induction. In children undergoing major surgery or in critically ill children, invasive blood pressure measurement is still the gold standard. Continuous noninvasive measurement methods could be an alternative in the future.Threshold values to define hypotension remain unknown, even in awake children. There are also little data on hypotension thresholds in the perioperative setting. The most reliable measurement parameter for estimating hypotension is the mean arterial pressure. The threshold values for intraoperative hypotension are 40 mm Hg in newborns, 45 mm Hg in infants, 50 mm Hg in young children and 65 mm Hg in adolescents. Treatment should be initiated at a deviation of 10% and intensified at a deviation of 20%.Bolus administration of isotonic balanced crystalloid solutions, vasopressors and/or catecholamines are used as treatment options. Consistent and rapid intervention in the event of hypotension appears to be crucial. So far there is no evidence as to whether this leads to an improvement in outcome parameters.
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