Hypotension During Surgery, Surgery-Complications
Conditions
Keywords
hypotension, post-anesthesia care unit, surgery, adult
Brief summary
The perioperative period poses a heightened risk of complications for patients, including hypotension. While the issue of intraoperative hypotension is well-documented in medical literature, the occurrence and causes of hypotension in the post-anesthesia care unit often receive less attention. This phase of postoperative care, however, is vital for ensuring patient stability and preventing severe consequences. Failure to identify and manage a drop in blood pressure can lead to hypoperfusion of critical organs, increasing the risk of morbidity and mortality. The aim of this study is to examine the frequency of hypotension in the post-anesthesia care unit-defined as systolic blood pressure \<90 mmHg or a drop of more than 20% from baseline-and to identify factors contributing to its development.
Detailed description
The perioperative period is a critical time for patients, marked by an increased risk of various complications, including hypotension. While intraoperative hypotension is extensively studied in medical literature, the occurrence and underlying causes of hypotension in the post-anesthesia care unit (PACU) often remain overlooked. This phase of postoperative care is essential for stabilizing the patient and preventing severe outcomes. A failure to identify and adequately address a drop in blood pressure during this time can result in hypoperfusion of vital organs, increasing the likelihood of morbidity and mortality. Hypotension in the PACU is defined as a systolic blood pressure below 90 mmHg or a decrease exceeding 20% compared to the patient's baseline measurements. The aim of this research is to explore the prevalence of hypotension in the PACU and to analyze the factors contributing to its occurrence. By improving the understanding of this issue, the study seeks to enhance patient outcomes through timely identification and management of hypotension in this crucial phase of care.
Interventions
None listed
Sponsors
Tomas Bata Hospital, Czech Republic
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to 105 Years
Healthy volunteers
Yes
Inclusion criteria
* patients over 18 years old * patients undergoing a procedure under general anesthesia * patients who have consented to data processing * postoperative stay in PACU
Exclusion criteria
* patients younger than 18 years old. * patients transferred directly to the ICU/Anesthesiology and Resuscitation Department after surgery without staying in the recovery room. * patients with incomplete medical documentation or missing blood pressure values in the recovery room. * patients with a pre-existing diagnosis of resistant hypotension or unstable hemodynamics before surgery * patients with a history of long-term use of anxiolytics, antipsychotics, or other psychotropic medications that may affect cognitive function, emotional state, or predictive outcomes * patient refusal to participate in the study (including cases where they initially consented), with an emphasis on respecting patient autonomy
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Incidence of hypotension in the post-anesthesia care unit (PACU). | 0. postoperative day | Hypotension is defined as systolic blood pressure \<90 mmHg or a decrease of more than 20% from baseline values. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Duration of the operation | 0. postoperative day | Duration of the surgical procedure as a risk factor for the development of postoperative hypotension. The duration will be recorded in minutes. |
| ASA classification (American Society of Anesthesiologists classification). | 0. postoperative day | ASA classification as a risk factor for the development of postoperative hypotension. ASA I: A normal healthy patient with no systemic disease. ASA II: A patient with mild systemic disease that does not limit daily activities (e.g., well-controlled diabetes or hypertension). ASA III: A patient with severe systemic disease that limits daily activities but is not incapacitating (e.g., poorly controlled diabetes or hypertension, chronic obstructive pulmonary disease). ASA IV: A patient with severe systemic disease that is a constant threat to life (e.g., unstable angina, symptomatic heart failure). ASA V: A moribund patient who is not expected to survive without surgery (e.g., ruptured abdominal aneurysm). |
| Type of anesthesia. | 0. postoperative day | The type of anesthesia used: general, regional, and/or peripheral nerve block. |
| Blood loss during the operation | 0. postoperative day | Blood loss during the surgical procedure, as documented in the surgical protocol. |
| Fluid balance during the surgery | 0. postoperative day | Fluid intake and output during surgery, measured in milliliters. |
| Surgical specialty | 0. postoperative day | Surgical specialties: neurosurgery, urology, gynecology, abdominal surgery, orthopedics |
| Fluid administration in the recovery room. | 0. postoperative day | Administration of a crystalloid or colloid bolus to augment intravascular volume. |
| Blood pressure monitoring. | 0. postoperative day | Repeated blood pressure measurement every 5 minutes. |
| Administration of vasopressors. | 0. postoperative day | In cases of severe hypotension, vasopressor administration (e.g., ephedrine, phenylephrine, norepinephrine) may be required to ensure adequate perfusion of vital organs. |
| Patient repositioning | 0. postoperative day | The Trendelenburg position (legs elevated above the head) can help increase venous return and consequently blood pressure. It will not be performed in surgeries involving the lower extremities. |
| Transfer of the patient to the ICU due to hemodynamic instability | 0. postoperative day | If hypotension does not improve despite repeated therapeutic interventions, escalation of care to the ICU may be necessary. |
| Postoperative nausea and vomiting | 0. postoperative day | Inadequate gastrointestinal perfusion can lead to nausea and vomiting, complicating the patient's recovery. |
| Impaired diuresis (oliguria, anuria) | 0. postoperative day | Oliguria is a medical term referring to low urine output, typically defined as producing less than 400-500 mL of urine per day in adults. Anuria is a medical condition characterized by the absence or near absence of urine production, typically defined as less than 100 mL of urine per day. |
| Impaired consciousness - GCS | 0. postoperative day | The Glasgow Coma Scale (GCS) is a clinical tool used to assess a person's level of consciousness after a brain injury. It evaluates three responses: eye opening, verbal response, and motor response, with scores ranging from 3 (deep coma) to 15 (fully alert). |
| Hypoxia | 0. postoperative day | Will be assessed using oxygen saturation levels (SpO₂). Mild hypoxia: SpO₂ 90-94% Moderate hypoxia:r SpO₂ 75-89% Severe hypoxia: SpO₂ \<75% |
| Lactic acidosis | 0. postoperative day | Lactic acidosis is a condition characterized by the accumulation of lactic acid in the bloodstream, leading to a decrease in blood pH. It can result from tissue hypoxia, impaired metabolism, or certain medical conditions. Lactic acidosis is generally defined by a serum lactate concentration above 4 mmol/L. Mild elevations in lactate (hyperlactatemia) occur at levels above 2 mmol/L, but true lactic acidosis is diagnosed when lactate levels exceed 4 mmol/L |
| Syncope | 0. postoperative day | Syncope is a temporary loss of consciousness due to a sudden decrease in blood flow to the brain. It typically has a rapid onset, short duration, and spontaneous recovery |
| Heart rate monitoring. | 0. postoperative day | Continuous heart rate monitoring. |
Countries
Czechia
Contacts
Primary ContactKlára Nekvindová, M.D., P.h.D.
Outcome results
None listed