Department of Anaesthetics, Imperial College Healthcare NHS Trust, London, UK.
Neurocritical Care, the National Hospital for Neurology and Neurosurgery, University College London Hospitals, Queen Square, London, UK.
Perioper Med (Lond). 2016 May 27;5:12. doi: 10.1186/s13741-016-0036-1. eCollection 2016.
Anaesthesia is frequently complicated by intraoperative hypotension (IOH) in the elderly, and this is associated with adverse outcome. The definition of IOH is controversial, and although management guidelines for IOH in the elderly exist, the frequency of IOH and typical clinically applied treatment thresholds are largely unknown in the UK.
We audited frequency of intraoperative blood pressure against national guidelines in elderly patients undergoing surgery. Depth of anaesthesia (DOA) monitoring was also audited due to the association between low DOA values and IOH with increased mortality (as part of "double" and "triple low" phenomena) and because it is a suggested management strategy to reduce IOH.
Twenty-five hospitals submitted data on 481 patients. Hypotension varied depending on the definition, but affected 400 patients (83.3 %) using the AAGBI standard. Furthermore, 2.9, 13.5, and 24.6 % had mean arterial blood pressures <50, <60, and <70 mmHg for 20 min, respectively, and 136 (28.4 %) had systolic blood pressure decrease by 20 % for 20 min. DOA monitors were used for 45 (9.4 %) patients.
IOH is common and use of DOA monitors is less than implied by guidelines. Improved management of IOH may be a simple intervention with real potential to reduce morbidity in this vulnerable group.
老年人在麻醉过程中经常出现术中低血压（IOH），这与不良预后有关。IOH 的定义存在争议，尽管存在老年人 IOH 的管理指南，但在英国，IOH 的频率和典型的临床应用治疗阈值在很大程度上尚不清楚。
我们审核了在接受手术的老年患者中根据国家指南监测术中血压的频率。由于低 DOA 值与 IOH 增加死亡率之间存在关联（作为“双重”和“三重低”现象的一部分），并且它是一种建议的管理策略，以降低 IOH，因此我们还审核了麻醉深度（DOA）监测。
25 家医院提交了 481 名患者的数据。低血压的定义各不相同，但根据 AAGBI 标准，有 400 名患者（83.3%）受到影响。此外，分别有 2.9%、13.5%和 24.6%的患者的平均动脉血压<50mmHg、<60mmHg 和<70mmHg 持续 20 分钟，136 名患者（28.4%）的收缩压下降 20%持续 20 分钟。有 45 名患者（9.4%）使用了 DOA 监测器。
IOH 很常见，而 DOA 监测器的使用频率低于指南所暗示的。改善 IOH 的管理可能是一种简单的干预措施，具有降低这一脆弱人群发病率的真正潜力。
