• Daniel I Sessler, Joshua A Bloomstone, Solomon Aronson, Colin Berry, Tong J Gan, John A Kellum, James Plumb, Monty G Mythen, Grocott Michael P W MPW Department of Anaesthesia, University College London, London, UK; Anaesthesia and Critical Care Research Unit, University Hospital Southampton NHS, Mark R Edwards, Timothy E Miller, Perioperative Quality Initiative-3 workgroup, POQI chairs, Michael Pw Grocott, Physiology group, Preoperative blood pressure group, Intraoperative blood pressure group, and Postoperative blood pressure group.
• Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland OH, USA. Electronic address: DS@OR.org.
• Br J Anaesth. 2019 May 1; 122 (5): 563-574.

BackgroundIntraoperative mortality is now rare, but death within 30 days of surgery remains surprisingly common. Perioperative myocardial infarction is associated with a remarkably high mortality. There are strong associations between hypotension and myocardial injury, myocardial infarction, renal injury, and death. Perioperative arterial blood pressure management was thus the basis of a Perioperative Quality Initiative consensus-building conference held in London in July 2017.MethodsThe meeting featured a modified Delphi process in which groups addressed various aspects of perioperative arterial pressure.ResultsThree consensus statements on intraoperative blood pressure were established. 1) Intraoperative mean arterial pressures below 60-70 mm Hg are associated with myocardial injury, acute kidney injury, and death. Injury is a function of hypotension severity and duration. 2) For adult non-cardiac surgical patients, there is insufficient evidence to recommend a general upper limit of arterial pressure at which therapy should be initiated, although pressures above 160 mm Hg have been associated with myocardial injury and infarction. 3) During cardiac surgery, intraoperative systolic arterial pressure above 140 mm Hg is associated with increased 30 day mortality. Injury is a function of arterial pressure severity and duration.ConclusionsThere is increasing evidence that even brief durations of systolic arterial pressure <100 mm Hg and mean arterial pressure <60-70 mm Hg are harmful during non-cardiac surgery.Copyright © 2019 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.

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