How do pediatric anesthesiologists define intraoperative hypotension?

Abstract

There is great variability in the BP parameters used and the threshold used for defining and treating IOH among pediatric anesthesiologists. The majority of respondents considered a 20-30% reduction from baseline in SBP as indicative of significant hypotension. Lack of a consensus definition for a common clinical condition like IOH could have implications for patient care as well as future clinical research.

Is blood pressure measurement important in children?

“…Children who undergo general anaesthesia are not in their "normal" state of health, and intraoperative BP is most commonly recorded by the oscillometric method. 1,14 Recent studies have suggested that these values are inappropriate in critically ill or injured children. The other question is whether or not SBP, DBP or MAP should be considered.…”

“…1,3 Unfortunately, most information on paediatric BP measurement is obtained via extrapolations from adult data.…”

“…Data from adult and paediatric victims of trauma have suggested that systolic blood pressure (SBP) is a predictor of mortality. In many other settings, the mean arterial pressure (MAP) has been used as a surrogate for tissue perfusion 1 and cardiac output (MAP = cardiac output x systemic vascular resistance). Routine monitoring of BP has thus been set as one of the recommended standards of care by the American Society of Anesthesiologists (ASA).…”

“…Routine monitoring of BP has thus been set as one of the recommended standards of care by the American Society of Anesthesiologists (ASA). 1 Paediatric anesthesiologists routinely monitor the BP of their patients and make major diagnostic and therapeutic decisions, e.g. blood transfusion and the commencement of inotropes and resuscitation, based on deviations from "normal".…”

A Presedation Fluid Bolus Does Not Decrease the Incidence of Propofol-Induced Hypotension in Pediatric Patients

“…15,16 The adult patients with secondary events had a higher American Society of Anesthesiologists (ASA) classifi cation and a lower baseline blood pressure, however. Other studies in the adult population have investigated preinduction treatments to prevent hypotension during propofol induction, including the use of isotonic fl uids, 17,18 Hetastarch, 19 ephedrine, 12,20,21 phenylephrine, 22 dopamine, dobu tamine, 20 ketamine, [23][24][25] and calcium chloride. 26 However, little research has been conducted specifi cally to determine whether there is a signifi cant risk to the pediatric patient during propofolinduced hypotension or whether there is an effective method to prevent the reduction in blood pressure associated with propofol induction in this patient population.…”