A Single-Center Descriptive Analysis of Interventions for Hypotension in Children: A Retrospective Cohort Study

Intraoperative hemodynamic management goals in pediatric patients vary significantly with age. Physiologic variability and the absence of a widely accepted definition of intraoperative hypotension contribute to inconsistent treatment thresholds and practice variation.

The primary aim was to observe which blood pressure thresholds in various age groups led to clinical intervention in noncardiac surgery. The secondary aim was to determine the most commonly employed treatment interventions.

A single-center, retrospective, observational cohort study analyzed anesthesia records for 37 958 pediatric patients aged < 18 years of age who underwent noncardiac surgery and general anesthesia at our institution from January 1, 2015, through December 31, 2023. Age groups included: infants (0-12 months), preschool (1-6 years), children (7-12 years), and teenagers (13-17 years). The primary outcome was the adjusted rate of intervention, defined as any bolus of ephedrine, phenylephrine, epinephrine, norepinephrine, vasopressin, or 5% albumin. An algorithmic approach was used to examine the time epoch both before (6 min) and after (3 min) any study-defined interventions to identify the lowest mean arterial pressure that was associated with an intervention.

Following exclusions, 37 958 anesthetic records were analyzed in this cohort. The median arterial pressure value and interquartile range associated with an intervention were: 36 mmHg [29, 43] in infants, 44 mmHg [38.5, 52] in preschool, 51 mmHg [44, 58] in children, and 57 mmHg [51, 63] in teenagers. The most common intervention was 5% albumin, followed by phenylephrine.

Intervention rates in pediatric patients were lower than those reported in adults, with intervention thresholds decreasing with younger age. Use of intravascular volume expansion appears to be more commonly used to treat hypotension in infants compared to older children. These findings highlight the need for multicenter studies to establish standardized intervention thresholds and assess their impact on clinical outcomes.