Perioperative management of blood pressure

Perioperative arterial hypotension is common. It is associated with death, kidney, myocardial and brain damage. There is no consensus definition, but the effect of low blood pressure is known to be the result of a threshold and time effect (more than 10 min below 80 mmHg mean blood pressure (MAP)). The objectives should be individualised according to the patient and the surgical risks. In healthy patients, a MAP of 60-65 mmHg would appear to be sufficient, whereas in patients with a higher surgical risk, a MAP greater than 75-80 mmHg and/or variations of less than 10-20% of the baseline value is more relevant. In the presence of perioperotive hypotension, hypnotic overdosoge should be ruled out. Thereafter, it is necessary to treat a low cardiac output by volume expansion, and/or to treat a decrease in systemic vascular resistance with vasopressors. In patients at risk, cardiac output must be monitored in order to adapt haemodynomic treatment to these different components. The two vasopressors of choice are ephedrine and norepinephrine, due to their combined actions alpha and beta. Continuous infusion (except for ephedrine) by peripheral venous route should be preferred.