Perioperative Quality Initiative consensus statement on preoperative blood pressure, risk and outcomes for elective surgery.
Blood Pressure
/ physiology
Cardiovascular Agents
/ administration & dosage
Contraindications, Procedure
Delphi Technique
Elective Surgical Procedures
/ adverse effects
Humans
Hypertension
/ complications
Perioperative Care
/ methods
Postoperative Complications
/ etiology
Preoperative Period
Prognosis
Risk Assessment
/ methods
arterial pressure
haemodynamics
perioperative care
preoperative blood pressure
surgical risk
Journal
British journal of anaesthesia
ISSN: 1471-6771
Titre abrégé: Br J Anaesth
Pays: England
ID NLM: 0372541
Informations de publication
Date de publication:
May 2019
May 2019
Historique:
received:
21
03
2018
revised:
18
12
2018
accepted:
01
01
2019
pubmed:
28
3
2019
medline:
23
4
2019
entrez:
28
3
2019
Statut:
ppublish
Résumé
A multidisciplinary international working subgroup of the third Perioperative Quality Initiative consensus meeting appraised the evidence on the influence of preoperative arterial blood pressure and community cardiovascular medications on perioperative risk. A modified Delphi technique was used, evaluating papers published in MEDLINE on associations between preoperative numerical arterial pressure values or cardiovascular medications and perioperative outcomes. The strength of the recommendations was graded by National Institute for Health and Care Excellence guidelines. Significant heterogeneity in study design, including arterial pressure measures and perioperative outcomes, hampered the comparison of studies. Nonetheless, consensus recommendations were that (i) preoperative arterial pressure measures may be used to define targets for perioperative management; (ii) elective surgery should not be cancelled based solely upon a preoperative arterial pressure value; (iii) there is insufficient evidence to support lowering arterial pressure in the immediate preoperative period to minimise perioperative risk; and (iv) there is insufficient evidence that any one measure of arterial pressure (systolic, diastolic, mean, or pulse) is better than any other for risk prediction of adverse perioperative events. Future research should define which preoperative arterial pressure values best correlate with adverse outcomes, and whether modifying arterial pressure in the preoperative setting will change the perioperative morbidity or mortality. Additional research should define optimum strategies for continuation or discontinuation of preoperative cardiovascular medications.
Sections du résumé
BACKGROUND
BACKGROUND
A multidisciplinary international working subgroup of the third Perioperative Quality Initiative consensus meeting appraised the evidence on the influence of preoperative arterial blood pressure and community cardiovascular medications on perioperative risk.
METHODS
METHODS
A modified Delphi technique was used, evaluating papers published in MEDLINE on associations between preoperative numerical arterial pressure values or cardiovascular medications and perioperative outcomes. The strength of the recommendations was graded by National Institute for Health and Care Excellence guidelines.
RESULTS
RESULTS
Significant heterogeneity in study design, including arterial pressure measures and perioperative outcomes, hampered the comparison of studies. Nonetheless, consensus recommendations were that (i) preoperative arterial pressure measures may be used to define targets for perioperative management; (ii) elective surgery should not be cancelled based solely upon a preoperative arterial pressure value; (iii) there is insufficient evidence to support lowering arterial pressure in the immediate preoperative period to minimise perioperative risk; and (iv) there is insufficient evidence that any one measure of arterial pressure (systolic, diastolic, mean, or pulse) is better than any other for risk prediction of adverse perioperative events.
CONCLUSIONS
CONCLUSIONS
Future research should define which preoperative arterial pressure values best correlate with adverse outcomes, and whether modifying arterial pressure in the preoperative setting will change the perioperative morbidity or mortality. Additional research should define optimum strategies for continuation or discontinuation of preoperative cardiovascular medications.
Identifiants
pubmed: 30916006
pii: S0007-0912(19)30057-1
doi: 10.1016/j.bja.2019.01.018
pii:
doi:
Substances chimiques
Cardiovascular Agents
0
Types de publication
Consensus Development Conference
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
552-562Investigateurs
Timothy E Miller
(TE)
Monty G Mythen
(MG)
Michael Pw Grocott
(MP)
Mark R Edwards
(MR)
Gareth L Ackland
(GL)
Charles S Brudney
(CS)
Maurizio Cecconi
(M)
Can Ince
(C)
Michael G Irwin
(MG)
Jonathan Lacey
(J)
Michael R Pinsky
(MR)
Robert Sanders
(R)
Finton Hughes
(F)
Angela Bader
(A)
Annemarie Thompson
(A)
Andreas Hoeft
(A)
David Williams
(D)
Andrew D Shaw
(AD)
Daniel I Sessler
(DI)
Sol Aronson
(S)
Colin Berry
(C)
Tong J Gan
(TJ)
John Kellum
(J)
James Plumb
(J)
Joshua Bloomstone
(J)
Matthew D McEvoy
(MD)
Julie K M Thacker
(JKM)
Ruchir Gupta
(R)
Elena Koepke
(E)
Aarne Feldheiser
(A)
Denny Levett
(D)
Frederic Michard
(F)
Mark Hamilton
(M)
Commentaires et corrections
Type : CommentIn
Type : CommentIn
Informations de copyright
Copyright © 2019 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.