Hypotension: Training for improved postoperative care

  • Virtual Patient Tour: Hypotension Matters – A Patient’s Journey on the Road to Hemodynamic Stability
  • 7 a.m.-5 p.m. Saturday-Tuesday
  • 7-11:30 a.m. Wednesday
  • North, Hall D

A successful surgery is a milestone moment for the anesthesiologist, surgeon, intensivist and the patient. Yet the first 30 days after surgery pose the greatest risk to patient survival. In fact, 30-day postoperative mortality is 1,000 times greater than preventable intraoperative mortality.

Two percent of U.S. surgical inpatients die within 30 days. Worldwide, at least 5 million patients die annually within a month of surgery. Half of 30-day mortality occurs during the initial hospitalization, despite being in the full care of the hospital staff. As such, postoperative mortality is a significant perioperative problem facing anesthesiologists, surgeons and critical care medicine physicians.

Ashish K. Khanna, M.D., will raise awareness of intraoperative hypotension on postoperative mortality.

“If the 30 days after surgery were considered a disease, it would be the third-leading cause of death,” said Ashish K. Khanna, M.D., an Intensivist and Anesthesiologist at Cleveland Clinic.

Recent studies suggest that intraoperative hypotension is to blame. More common than anesthesiologists may think, even mild intraoperative hypotension is associated with myocardial injury and death. To raise awareness of the problem, ASA will host “Virtual Patient Tour: Hypotension Matters — A Patient’s Journey on the Road to Hemodynamic Stability.” Working from iPads, this virtual patient safety module gives attendees a self-directed learning opportunity to navigate three scenarios of hypotension — preoperatively, intraoperatively and postoperatively. Each scenario gives users an opportunity to decide what it takes to achieve hemodynamic stability.

The self-study module was provided through an educational grant from Edwards Lifesciences and is available each day during conference hours.

The module provides multiple strategies to safely deliver patients to the PACU. This includes identifying preoperative predictors of intraoperative hemodynamic instability, preventing unfavorable swings of blood pressure in the O.R., intervening to keep mean arterial pressures above clearly defined thresholds in the O.R. and the ICU, identifying the challenges of hemodynamic monitoring and early signs of decompensation in the PACU and developing an effective mechanism of maintaining hemodynamic stability in the ICU, especially during intubation and resuscitation measures in critically ill patients.

It’s common for intraoperative blood pressure to vary during noncardiac surgery. A recent study analyzing blood pressure data from anesthesia information management systems (AIMS) found hypotension in 26 percent of patients and hypertension in 20 percent of cases. There are no acceptable definitions for intraoperative blood pressure levels that require intervention. In addition, blood thresholds and outcomes in the ICU have been questioned as well. Thresholds that were previously considered to be normal may no longer be acceptable.

According to Dr. Khanna, anesthesiologists and intensivists need to work as a team and train on strategies to move beyond the O.R., as postoperative mortality continues to be an issue.

“Anesthesiologists can make a significant impact on postoperative outcomes. The need is to participate meaningfully in postoperative care and for critical care physicians to work hand-in-hand in this vital matter,” Dr. Khanna said.

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