• Br J Anaesth · Nov 2023

    Review Meta Analysis

    Intraoperative hypotension and postoperative outcomes: a meta-analysis of randomised trials.

    Permissive intra-operative hypotension (MAP ≤60 mmHg) was not associated with increased mortality, but perplexingly was associated with reduced AF and hospital stay.

    • Filippo D'Amico, Evgeny V Fominskiy, Stefano Turi, Alessandro Pruna, Stefano Fresilli, Margherita Triulzi, Alberto Zangrillo, and Giovanni Landoni.
    • Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy.
    • Br J Anaesth. 2023 Nov 1; 131 (5): 823831823-831.

    IntroductionIntraoperative hypotension is associated with adverse postoperative outcomes; however these findings are supported only by observational studies. The aim of this meta-analysis of randomised trials was to compare the postoperative effects permissive management with targeted management of intraoperative blood pressure.MethodsWe searched PubMed, Cochrane, and Embase up to June 2023 for studies comparing permissive (mean arterial pressure ≤60 mm Hg) with targeted (mean arterial pressure >60 mm Hg) intraoperative blood pressure management. Primary outcome was all-cause mortality at the longest follow-up available. Secondary outcomes were atrial fibrillation, myocardial infarction, acute kidney injury, delirium, stroke, number of patients requiring transfusion, time on mechanical ventilation, and length of hospital stay.ResultsWe included 10 randomised trials including a total of 9359 patients. Mortality was similar between permissive and targeted blood pressure management groups (89/4644 [1.9%] vs 99/4643 [2.1%], odds ratio 0.88, 95% confidence interval [CI], 0.65-1.18, P=0.38, I2=0% with nine studies included). Atrial fibrillation (102/3896 [2.6%] vs 130/3887 [3.3%] odds ratio 0.71, 95% CI 0.53-0.96, P=0.03, I2=0%), and length of hospital stay (mean difference -0.20 days, 95% CI -0.26 to -0.13, P<0.001, I2=0%) were reduced in the permissive management group. No significant differences were found in subgroup analysis for cardiac and noncardiac surgery.ConclusionPooled randomised evidence shows that a target intraoperative mean arterial pressure ≤60 mm Hg is not associated with increased mortality; nevertheless it is surprisingly associated with a reduced rate of atrial fibrillation and of length of hospital stay.Systematic Review ProtocolPROSPERO CRD42023393725.Copyright © 2023 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.

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    Permissive intra-operative hypotension (MAP ≤60 mmHg) was not associated with increased mortality, but perplexingly was associated with reduced AF and hospital stay.

    Daniel Jolley  Daniel Jolley
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