• Frank Weber, Laurens Koning, and Gail P Scoones.
• Department of Anaesthesia, Sophia Children's Hospital, Erasmus University Medical Center, Rotterdam, The Netherlands.
• Paediatr Anaesth. 2017 Apr 1; 27 (4): 377-384.

BackgroundBlood pressure (BP) is the most commonly applied clinical surrogate parameter for tissue perfusion and cerebral autoregulation. Hypotension during anesthesia may contribute to unfavorable outcome in young children. Hypotension in anesthetized infants can be defined using BP values relative to individual awake baseline or absolute BP values.AimThe aim of this study was to investigate the applicability of the two definitions and to compare the incidences of hypotension.MethodThis was a prospective observational study in 151 infants <12 months of age. The percentage of successful awake BP measurements was calculated and related to the infant's behavioral state. Hypotension under sevoflurane anesthesia was defined by a decrease of mean arterial pressure (MAP) relative to awake baseline (>20% in infants <6 months, >40% in infants >6 months) or absolute MAP values (<35 mmHg in infants <6 months, <43 mmHg in infants >6 months). The incidences of hypotension using the two definitions were compared.ResultsAwake BP values were obtained in 85% of the patients. Calm patients were more likely to allow their BP to be measured than anxious patients. Anxious patients had higher preinduction MAP values than calm patients. The relative BP approach resulted in a higher incidence of postinduction hypotension than using absolute BP values.ConclusionsAwake BP values were unobtainable in 15% of our patients, resulting in the necessity to define hypotension under anesthesia using absolute BP values. Definitions of hypotension using either absolute MAP or values relative to awake baseline are not interchangeable.© 2017 John Wiley & Sons Ltd.

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