• Bernd Saugel, Philip C Reese, Daniel I Sessler, Christian Burfeindt, Julia Y Nicklas, Hans O Pinnschmidt, Daniel A Reuter, and Stefan Südfeld.
• From the Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine (B.S., P.C.R., C.B., J.Y.N., S.S.) the Department of Medical Biometry and Epidemiology (H.O.P.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany the Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio (D.I.S.) the Department of Anesthesiology and Intensive Care Medicine, University Medical Center Rostock, Rostock, Germany (D.A.R.).
• Anesthesiology. 2019 Jul 1; 131 (1): 74-83.

BackgroundNormal blood pressure varies among individuals and over the circadian cycle. Preinduction blood pressure may not be representative of a patient's normal blood pressure profile and cannot give an indication of a patient's usual range of blood pressures. This study therefore aimed to determine the relationship between ambulatory mean arterial pressure and preinduction, postinduction, and intraoperative mean arterial pressures.MethodsAmbulatory (automated oscillometric measurements at 30-min intervals) and preinduction, postinduction, and intraoperative mean arterial pressures (1-min intervals) were prospectively measured and compared in 370 American Society of Anesthesiology physical status classification I or II patients aged 40 to 65 yr having elective noncardiac surgery with general anesthesia.ResultsThere was only a weak correlation between the first preinduction and mean daytime mean arterial pressure (r = 0.429, P < 0.001). The difference between the first preinduction and mean daytime mean arterial pressure varied considerably among individuals. In about two thirds of the patients, the lowest postinduction and intraoperative mean arterial pressures were lower than the lowest nighttime mean arterial pressure. The difference between the lowest nighttime mean arterial pressure and a mean arterial pressure of 65 mmHg varied considerably among individuals. The lowest nighttime mean arterial pressure was higher than 65 mmHg in 263 patients (71%).ConclusionsPreinduction mean arterial pressure cannot be used as a surrogate for the normal daytime mean arterial pressure. The lowest postinduction and intraoperative mean arterial pressures are lower than the lowest nighttime mean arterial pressure in most patients.

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