NDLI: Association of Intraoperative Hypotension with Postoperative Acute Kidney and Myocardial Injuries in Noncardiac Surgery Patients

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Association of Intraoperative Hypotension with Postoperative Acute Kidney and Myocardial Injuries in Noncardiac Surgery Patients

Content Provider	Semantic Scholar
Author	Leffert, Lisa Rae Schwamm, Lee H.
Copyright Year	2014
Abstract	To the Editor: In an observational study including 33,330 noncardiac surgeries performed in 27,381 patients with detailed intraoperative blood pressures, Walsh et al.1 showed that intraoperative mean arterial pressure less than 55 mmHg was associated Specifically, we would like to remind the reader against maneuvers that will acutely lower the cerebrospinal fluid pressure in the lumbar cistern of patients who already have imaging evidence of a shift of brain tissue into neighboring compartments. The laws of physics dictate that when a pressure gradient develops between two compartments, there will be a movement to equilibrate this difference. When this occurs rapidly across the foramen magnum and without ample and free-flowing intracranial cerebrospinal fluid in reserve, brain tissue will shift. This produces neurologic impairment which may progress to stupor or coma if untreated. However, many patients with intracranial lesions with favorable characteristics can safely receive neuraxial anesthetics, as is catalogued in the online supplementary material to our review.1 We thank Dr. Derakhshan for reinforcing the point that that not all patients with intracranial lesions will develop devastating neurologic complications from brain herniation, and hope that our article has empowered the reader to be a more thoughtful participant in the conversation about what anesthesia technique is best for individual patients.
File Format	PDF HTM / HTML
Alternate Webpage(s)	http://anesthesiology.pubs.asahq.org/pdfaccess.ashx?url=/data/journals/jasa/930982/20140500.0-00041.pdf
Language	English
Access Restriction	Open
Content Type	Text
Resource Type	Article

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