Possibilities of diagnostics and prevention of intraoperative hypotension development

Intraoperative hypotension is a clinical problem, the essence of which is a decrease in blood pressure during surgical procedures, leading to various complications in the intra- and postoperative period (acute kidney injury, postoperative delirium, stroke, and myocardial infarction). According to a number of studies, intraoperative hypotension is associated with increased hospital mortality in any operated patients, which explains the practical significance of this pathologic condition. Therefore, the issues related to the study of pathogenesis mechanisms, methods of prediction and prevention of intraoperative hypotension remain the subject of actual scientific search. For example, a number of studies are aimed at individual normal blood pressure determination, but this problem still unsolved. The pathophysiology of this condition is also a subject for study. It is known that during induction of anesthesia, the most common cause of hypotension is the side effects of drugs, and during the main stage of surgery it is blood loss. In both cases, the leading pathogenetic mechanism of hypotension is the insufficiency of the patient’s cardiovascular system to the onset of hemodynamic changes. Taking into account the heterogeneity of the cardiovascular system’s preoperative state in different patients and the extremely diverse format of surgical interventions, a personalized approach to the prediction, prevention and correction of intraoperative hypotension becomes of key importance. In recent years, the prediction and prevention of hypotension has become a subject of scientific interest. Hypovolemia is one of the main intraoperative hypotension’s pathophysiologic factors. Therefore, correction of volemic status is considered as a perioperative pressure reduction prevention method. As part of the personalized approach, the intraoperative hypotension prevention algorithms are used. These algorithms are based on the preoperative assessment of the patient’s volemic status using different instrumental tools. Some of such algorithms are summarized in the review.

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