Blood pressure targets during general anaesthesia for noncardiac surgery

Bolther, Maria; Henriksen, Jeppe; Holmberg, Mathias J.; Granfeldt, Asger; Andersen, Lars W.

doi:10.1097/eja.0000000000001703

Cited by 4 publications

(8 citation statements)

References 14 publications

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“…Overall, the search identified 23,454 unique records of which 535 full-text articles were assessed for eligibility. Of 209 manuscripts included in previous reviews, [4][5][6][7] 63 manuscripts including relevant outcomes for the current manuscript were identified. Review of references and previous reviews resulted in identification of two additional manuscripts, yielding a total of 65 manuscripts (Figure S1).…”

Section: Resultsmentioning

confidence: 99%

“…This paper is part of a larger systematic review project including clinical trials assessing various respiratory and hemodynamic interventions and targets for patients undergoing non‐cardiac surgery under general anesthesia. Previous manuscripts from this review project have focused on the outcomes mortality, length of stay, and postoperative complications 4–7 . In this manuscript, we focus on the outcomes of postoperative pain, nausea, and vomiting.…”

Section: Methodsmentioning

confidence: 99%

“…Previous manuscripts from this review project have focused on the outcomes mortality, length of stay, and postoperative complications. [4][5][6][7] In this manuscript, we focus on the outcomes of postoperative pain, nausea, and vomiting.…”

Section: Protocol and Registrationmentioning

confidence: 99%

“…Pre‐, intra‐, and postoperatively, various medical interventions are used to minimize pain, nausea, and vomiting in the postoperative setting and avoid severe complications 3 . Recent reviews have shown limited effects of specific intra‐operative respiratory and hemodynamic interventions on “hard” endpoints such as hospital length of stay and mortality 4–7 . However, identification of intraoperative respiratory and hemodynamic interventions and specific targets that can influence the development and intensity of postoperative pain, nausea, and vomiting would be valuable additions in a multimodal approach.…”

Section: Introductionmentioning

confidence: 99%

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Intraoperative respiratory and hemodynamic strategies for reducing nausea, vomiting, and pain after surgery: Systematic review and meta‐analysis

Holst

Klitholm

Henriksen

et al. 2022

Acta Anaesthesiol Scand

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Background: Despite improved medical treatment strategies, postoperative pain, nausea, and vomiting remain major challenges. This systematic review investigated the relationship between perioperative respiratory and hemodynamic interventions and postoperative pain, nausea, and vomiting. Methods: PubMed and Embase were searched on March 8, 2021 for randomized clinical trials investigating the effect of perioperative respiratory or hemodynamic interventions in adults undergoing non-cardiac surgery. Investigators reviewed trials for relevance, extracted data, and assessed risk of bias. Meta-analyses were performed when feasible. GRADE was used to assess the certainty of the evidence.Results: This review included 65 original trials; of these 48% had pain, nausea, and/or vomiting as the primary focus. No reduction of postoperative pain was found in meta-analyses when comparing recruitment maneuvers with no recruitment, high (80%) to low (30%) fraction of oxygen, low (5-7 ml/kg) to high (9-12 ml/kg) tidal volume, or goal-directed hemodynamic therapy to standard care.

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Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Protocol and Registrationmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Intraoperative respiratory and hemodynamic strategies for reducing nausea, vomiting, and pain after surgery: Systematic review and meta‐analysis

Holst

Klitholm

Henriksen

et al. 2022

Acta Anaesthesiol Scand

Self Cite

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“…The challenge with individualizing intraoperative blood pressure targets may explain the paucity of interventions proven to reduce exposure to intraoperative hypotension and reduce risks of subsequent end-organ injury. Randomized trials that assigned arbitrary fixed intraoperative blood pressure targets to all patients, such as targeting a mean arterial pressure of 75 versus 65 mm Hg,29 have not improved clinical outcomes 30. By comparison, trials that applied individualized intraoperative blood pressure targets have shown more promise 30.…”

Section: Blood Pressure: Chronic Hypertension and Perioperative Hypot...mentioning

confidence: 99%

Cardiac assessment and management in older surgical patients

Amado

Wijeysundera

2023

International Anesthesiology Clinics

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The aging global population has a profound impact on patient management in the perioperative setting. Older patients represent an ever-growing proportion of patients presenting for surgery, 1 and face an elevated risk for adverse outcomes. The elevated risk is explained by a high burden of comorbid disease associated with elevated age (eg, cardiovascular disease), age-associated geriatric syndromes (eg, frailty), and physiological changes directly related to aging.Cellular senescence explains many of these changes. Human cells only replicate a finite number of times; telomere shortening occurs during every replication cycle, thereby exposing DNA to damage. 2 Reduced regenerative capacity, along with other changes at a molecular and cellular level (eg, free radical production), result in pathophysiological changes seen in old age. In the cardiovascular system, aging results in loss of vascular compliance, endothelial dysfunction, changes in cardiac structure and function (myocardial remodeling, diastolic dysfunction, cardiac conduction system degeneration), and altered cardiac response to stress (eg, attenuated baroreceptor response). 3,4 These changes culminate in reduced cardiovascular function and reduced capacity to respond to acute physiological stressors. Preoperative cardiac assessment of older adults should address the sequalae of these age-related changes.In this review, we discuss several cardiac conditions especially relevant to older surgical patients (ie, hypertension, ischemic heart disease (IHD)]. We also address the role of multidimensional geriatric assessment as a component of high-quality preoperative evaluation. 5

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Comparison of Machine Learning Models Including Preoperative, Intraoperative, and Postoperative Data and Mortality After Cardiac Surgery

et al. 2022

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ImportanceA variety of perioperative risk factors are associated with postoperative mortality risk. However, the relative contribution of routinely collected intraoperative clinical parameters to short-term and long-term mortality remains understudied.ObjectiveTo examine the performance of multiple machine learning models with data from different perioperative periods to predict 30-day, 1-year, and 5-year mortality and investigate factors that contribute to these predictions.Design, Setting, and ParticipantsIn this prognostic study using prospectively collected data, risk prediction models were developed for short-term and long-term mortality after cardiac surgery. Included participants were adult patients undergoing a first-time valve operation, coronary artery bypass grafting, or a combination of both between 1997 and 2017 in a single center, the University Medical Centre Groningen in the Netherlands. Mortality data were obtained in November 2017. Data analysis took place between February 2020 and August 2021.ExposureCardiac surgery.Main Outcomes and MeasuresPostoperative mortality rates at 30 days, 1 year, and 5 years were the primary outcomes. The area under the receiver operating characteristic curve (AUROC) was used to assess discrimination. The contribution of all preoperative, intraoperative hemodynamic and temperature, and postoperative factors to mortality was investigated using Shapley additive explanations (SHAP) values.ResultsData from 9415 patients who underwent cardiac surgery (median [IQR] age, 68 [60-74] years; 2554 [27.1%] women) were included. Overall mortality rates at 30 days, 1 year, and 5 years were 268 patients (2.8%), 420 patients (4.5%), and 612 patients (6.5%), respectively. Models including preoperative, intraoperative, and postoperative data achieved AUROC values of 0.82 (95% CI, 0.78-0.86), 0.81 (95% CI, 0.77-0.85), and 0.80 (95% CI, 0.75-0.84) for 30-day, 1-year, and 5-year mortality, respectively. Models including only postoperative data performed similarly (30 days: 0.78 [95% CI, 0.73-0.82]; 1 year: 0.79 [95% CI, 0.74-0.83]; 5 years: 0.77 [95% CI, 0.73-0.82]). However, models based on all perioperative data provided less clinically usable predictions, with lower detection rates; for example, postoperative models identified a high-risk group with a 2.8-fold increase in risk for 5-year mortality (4.1 [95% CI, 3.3-5.1]) vs an increase of 11.3 (95% CI, 6.8-18.7) for the high-risk group identified by the full perioperative model. Postoperative markers associated with metabolic dysfunction and decreased kidney function were the main factors contributing to mortality risk.Conclusions and RelevanceThis study found that the addition of continuous intraoperative hemodynamic and temperature data to postoperative data was not associated with improved machine learning–based identification of patients at increased risk of short-term and long-term mortality after cardiac operations.

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Blood pressure targets during general anaesthesia for noncardiac surgery

Cited by 4 publications

References 14 publications

Intraoperative respiratory and hemodynamic strategies for reducing nausea, vomiting, and pain after surgery: Systematic review and meta‐analysis

Intraoperative respiratory and hemodynamic strategies for reducing nausea, vomiting, and pain after surgery: Systematic review and meta‐analysis

Cardiac assessment and management in older surgical patients

Comparison of Machine Learning Models Including Preoperative, Intraoperative, and Postoperative Data and Mortality After Cardiac Surgery

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