Hemodynamic instability and intraoperative hypotension (IOH)
Hemodynamic instability and intraoperative hypotension (IOH) present important challenges for surgical patients Despite recent efforts by anesthesia professionals to reduce IOH, evidence suggests that certain interventions might inadvertently harm patients Current consensus recommendations stress the necessity of improving our understanding of hemodynamic instability by raising awareness of its association with adverse outcomes, educating healthcare providers about the pathophysiology of IOH, underscoring the value of early detection, and advocating for appropriate hemodynamic management
Definition
IOH encompasses reductions in mean arterial pressure (MAP) during surgery Definitions vary, but the most common element is MAP < 65 mm Hg The duration of this low MAP varies from at least 1 minute to 15 minutes or more The incidence rate described in the literature varies depending on the definition use, but recent studies show 19 3% to 30 9% incidence for MAP < 65 mm Hg
Pre-operative and
Surgical manipulation or procedures
Postoperative Complications
Acute Kidney Injury (AKI)
Surgical Site Infections (SSIs)
Myocardial Injury after Non-cardiac Surgery (MINS) Pneumonia
Mortality
Postoperative cognitive dysfunction/delirium
Factors Influencing IOH Negative Outcomes
Severity of Hypotension
References
Calvo-Vecino JM, Ripollés-Melchor J, Mythen MG, et al. Effect of goaldirected haemodynamic therapy on postoperative complications in lowmoderate risk surgical patients: a multicentre randomised controlled trial (FEDORA trial). . 2018;120(4):734-744. doi:10.1016/j.bja.2017.12.018
Br J Anaesth
Chiu C, Fong N, Lazzareschi D, et al. Fluids, vasopressors, and acute kidney injury after major abdominal surgery between 2015 and 2019: a multicentre retrospective analysis. . 2022;129(3):317-326. doi:10.1016/j.bja.2022.05.002
Br J Anaesth
Anesthesiol Clin
French WB, Scott M. Fluid and Hemodynamics. . 2022;40(1):59-71. doi:10.1016/j.anclin.2021.11.002
Glassman SD, Carreon LY, Djurasovic M, et al. Intra-Operative Hypotension is an Important Modifiable Risk Factor for Major Complications in Spinal Fusion Surgery. . Published online May 8, 2024. doi:10.1097/BRS.0000000000005030
Analg
Gregory A, Stapelfeldt WH, Khanna AK, et al. Intraoperative hypotension is associated with adverse clinical outcomes after noncardiac surgery. . 2021;132(6):1654-1665. doi:10.1213/ANE.0000000000005250
Martin GS, Kaufman DA, Marik PE, et al. Perioperative Quality Initiative (POQI) consensus statement on fundamental concepts in perioperative fluid management: fluid responsiveness and venous capacitance. . 2020;9:12. Published 2020 Apr 21. doi:10.1186/s13741-02000142-8
Anesth Perioper Med (Lond) J Clin Anesth
Saasouh W, Christensen AL, Chappell D, et al. Intraoperative hypotension in ambulatory surgery centers. . 2023;90:111181. doi:10.1016/j.jclinane.2023.111181
Spine (Phila Pa 1976) Anesthesiology
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. . 2017;126(1):4765. doi:10.1097/ALN.0000000000001432
Sessler DI, Bloomstone JA, Aronson S, et al. Perioperative Quality Initiative consensus statement on intraoperative blood pressure, risk and outcomes for elective surgery. . 2019;122(5):563-574. doi:10.1016/j.bja.2019.01.013
Br J Anaesth
References
Scott MJ, APSF Hemodynamic Instability Writing Group. Perioperative Patients With Hemodynamic Instability: Consensus Recommendations of the Anesthesia Patient Safety Foundation. . 2024;138(4):713724. doi:10.1213/ANE.0000000000006789
Yerdon A, Sherrer DM, Chappell D. Intraoperative Hypotension: A Public Safety Announcement for Anesthesia Professionals. . 2024; 39(2): 42-45.
Yerdon A, Woodfin K, Richey R, McMullan S. Predicting Intraoperative Hypotension: An Intraoperative Case Report. . 2024;92(4):288-293.
Yerdon A, Taylor K, Woodfin K, Richey R, McMullan S, Chappell D. Goaldirected Therapy: What is the goal again? Perioperative Medicine. 2025/05/16 2025;14(1):57. doi:10.1186/s13741-025-00533-9 Anesth Analg APSF Newsletter AANA J