[Intraoperative hypotension in children-Measurement and treatment].

Die Anaesthesiologie Pub Date : 2024-11-01 Epub Date: 2024-09-27 DOI:10.1007/s00101-024-01461-x
Sebastian Bratke, Sebastian Schmid, Vijyant Sabharwal, Bettina Jungwirth, Karin Becke-Jakob
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Abstract

Intraoperative hypotension is a common perioperative complication in pediatric anesthesia. Oscillometric blood pressure measurement is therefore an essential part of standard perioperative monitoring in pediatric anesthesia. The optimum measurement site is the upper arm. Attention must be paid to the correct cuff size. Blood pressure should be measured before induction. In children undergoing major surgery or in critically ill children, invasive blood pressure measurement is still the gold standard. Continuous noninvasive measurement methods could be an alternative in the future.Threshold values to define hypotension remain unknown, even in awake children. There are also little data on hypotension thresholds in the perioperative setting. The most reliable measurement parameter for estimating hypotension is the mean arterial pressure. The threshold values for intraoperative hypotension are 40 mm Hg in newborns, 45 mm Hg in infants, 50 mm Hg in young children and 65 mm Hg in adolescents. Treatment should be initiated at a deviation of 10% and intensified at a deviation of 20%.Bolus administration of isotonic balanced crystalloid solutions, vasopressors and/or catecholamines are used as treatment options. Consistent and rapid intervention in the event of hypotension appears to be crucial. So far there is no evidence as to whether this leads to an improvement in outcome parameters.

[儿童术中低血压--测量和治疗]。
术中低血压是小儿麻醉围术期常见的并发症。因此,示波血压测量是小儿麻醉围术期标准监测的重要组成部分。最佳测量部位是上臂。必须注意袖带的正确尺寸。应在诱导前测量血压。对于接受大手术的儿童或重症儿童,有创血压测量仍是金标准。即使在清醒的儿童中,定义低血压的阈值仍然未知。关于围手术期低血压阈值的数据也很少。估计低血压最可靠的测量参数是平均动脉压。新生儿术中低血压的阈值为 40 毫米汞柱,婴儿为 45 毫米汞柱,幼儿为 50 毫米汞柱,青少年为 65 毫米汞柱。等渗平衡晶体液、血管加压剂和/或儿茶酚胺可作为治疗选择。在出现低血压时,持续、快速的干预似乎至关重要。到目前为止,还没有证据表明这样做是否能改善结果参数。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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