Perioperative blood pressure variability in patients undergoing coronary artery bypass grafting: its magnitude and determinants.

OBJECTIVES

The study aimed to assess the magnitude and determinants of perioperative blood pressure (BP) variability in patients undergoing coronary artery bypass grafting (CABG) with the use of extracorporeal circulation (ECC).

METHODS

Two hundred patients were enrolled, 41 women (21%) and 159 men (79%), aged 6 1± 8 years. A direct method of intraoperative BP measurement was used with a cannula placed in the radial artery, and BP was recorded at intervals of 5 min at three stages of the CABG: from cannula placement to the start of ECC, during ECC, and post-ECC until the transfer of patient to the postoperative room. BP variability was assessed using coefficient of variation (in percentage) for systolic, diastolic, mean, and pulse pressures. Impact of sex, age, and comorbidities was determined.

RESULTS

Greater changes in BP during CABG were observed in diastolic BP (4/19%) than in systolic BP (11/15%) and the greatest BP variability was associated with pulse pressure (20/72%). The greatest variability of BP parameters was found during ECC (15/72%). Higher BP lability was found in women (13/83%), younger patients (11/78%), and those without diabetes (11/78%), hypertension (11/82%), or obesity (11/71%), and smoking habit increased the variability during CABG (11/89%). All trends were similar for all types of BP.

CONCLUSION

Special attention in perioperative anesthetic management should be given not only to elder patients with many comorbid conditions, but also to younger and healthier participants because the latter are characterized by greater variations of BP during CABG.