Anestéziológia a intenzívna medicína 2/2019
Management of hypotension during anesthesia in children
Routine monitoring of blood pressure is an essential part of perioperative care in adults and children. It is however not known whether intraoperative hypotension (IOH) is clinically important in the pediatric patient. There is great variability in the BP parameters used and the threshold used for defining and treating IOH. Most guidelines define hypotensionas a systolic BP (SBP) below the 5th percentile for age. The majority of pediatric anesthesiologists considered a 20–30 % reduction from baseline in SBP as indicative of significant hypotension. Hypotension may be due to a low cardiac output, low systemic vascular resistance or a combination of both. Untreated, it may result in inadequate organ perfusion. Initial management usually involves fluid bolus to optimise preload, and use of drugs to increase contractility and provide vasoconstriction. Thorough evaluation of the patient is required to identify specific underlying causes. The immediate management of a severe hypotensive episode should follow the diagnosis. An algorithm based approach can facilitate diagnosis and management.
Keywords: pediatric patients, anaesthesia, hypotension
