Perioperative blood pressure in the elderly
- PMID: 31833866
- DOI: 10.1097/ACO.0000000000000820
Perioperative blood pressure in the elderly
Abstract
Purpose of review: Hemodynamic instability is common in the perioperative period because of obligate physiologic changes that occur with surgery. Despite the frequency of such hemodynamic changes and the potential harm associated with them, particularly in the elderly, guidelines to optimize perioperative blood pressure are lacking. The present review examines recent evidence for perioperative blood pressure management in the elderly.
Recent findings: Hypotension has been associated with poor outcomes, particularly renal injury, myocardial injury, and increased mortality, in the perioperative period. Hypertension, tachycardia, frequency of blood pressure monitoring, and management of chronic antihypertensive medications may also affect patient outcomes. Elderly patients may be especially prone to adverse events associated with perioperative hemodynamic instability.
Summary: Precise and intentional management of hemodynamic parameters, medication regimens, and blood pressure monitoring may reduce adverse events in elderly patients undergoing surgery. Further investigation is required to identify the exact hemodynamic parameters that mitigate risk.
References
-
- Hallqvist L, Granath F, Huldt E, et al. Intraoperative hypotension is associated with acute kidney injury in noncardiac surgery: An observational study. Eur J Anaesthesiol 2018; 35:273–279.
-
- Venkatesan S, Myles PR, Manning HJ, et al. Cohort study of preoperative blood pressure and risk of 30-day mortality after elective noncardiac surgery. Br J Anaesth 2017; 119:65–77.
-
- Sessler DI, Bloomstone JA, Aronson S, et al. Perioperative Quality Initiative consensus statement on intraoperative blood pressure, risk and outcomes for elective surgery. Br J Anaesth 2019; 122:563–574.
-
- Salmasi V, Maheshwari K, Yang D, et al. Relationship between intraoperative hypotension, defined by either reduction from baseline or absolute thresholds, and acute kidney and myocardial injury after noncardiac surgery: a retrospective cohort analysis. Anesthesiology 2017; 126:47–65.
-
- Gu WJ, Hou BL, Kwong JSW, et al. Association between intraoperative hypotension and 30-day mortality, major adverse cardiac events, and acute kidney injury after noncardiac surgery: a meta-analysis of cohort studies. Int J Cardiol 2018; 258:68–73.
Publication types
MeSH terms
Substances
LinkOut - more resources
Full Text Sources
Medical
Research Materials