Robert D Sanders1, Fintan Hughes2, Andrew Shaw3, Annemarie Thompson4, Angela Bader5, Andreas Hoeft6, David A Williams4, Michael P W Grocott7, Monty G Mythen8, Timothy E Miller4, Mark R Edwards9. 1. Department of Anesthesiology, University of Wisconsin, Madison, WI, USA. Electronic address: robert.sanders@wisc.edu. 2. University College London/University College London Hospital National Institute of Health Research Biomedical Research Centre, London, UK. 3. Department of Anesthesia and Pain Medicine, University of Alberta, Edmonton, AB, Canada. 4. Department of Anesthesiology, Duke Medical Center, Durham, NC, USA. 5. Department of Anesthesiology, Brigham and Women's Hospital, Boston, MA, USA. 6. Anesthesiology and Intensive Care Medicine, University of Bonn, Bonn, Germany. 7. Acute, Critical and Perioperative Care Research Area, NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK; Integrative Physiology and Critical Illness Group, Clinical and Experimental Sciences, University of Southampton, Southampton, UK; Anaesthesia and Critical Care Research Unit, Department of Anaesthesia, University Hospital Southampton NHS Foundation Trust, Southampton, UK; Department of Anaesthesia, University College London, London, UK. 8. University College London/University College London Hospital National Institute of Health Research Biomedical Research Centre, London, UK; Department of Anaesthesia, University College London, London, UK. 9. Acute, Critical and Perioperative Care Research Area, NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK; Integrative Physiology and Critical Illness Group, Clinical and Experimental Sciences, University of Southampton, Southampton, UK; Anaesthesia and Critical Care Research Unit, Department of Anaesthesia, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
Abstract
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: 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: 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: 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.
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: 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: 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: 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.