Navigating intraoperative hypotension: rethinking traditional management for improved patient outcomes

Abstract

Intraoperative hemodynamic instability and hypotension commonly occur in anesthetized patients and are associated with postoperative morbidity and mortality. A growing body of evidence establishes a strong correlation between intraoperative hypotension (IOH) and adverse events such as acute kidney injury (AKI), myocardial injury, postoperative cognitive dysfunction, and mortality. Recent recommendations for mean arterial pressure (MAP) maintenance above 65 mm Hg and consensus guidelines endorsing a MAP target of 60–70 mm Hg highlight the imperative for meticulous hemodynamic management. However, achieving this goal presents challenges for anesthesia clinicians. This article reviews issues with recent trends in hemodynamic monitoring and management strategies, emphasizing the importance of avoiding unintended patient harm by looking beyond traditional blood pressure management, such as relying solely on vasopressors.