Title |
Care of elderly patients: a prospective audit of the prevalence of hypotension and the use of BIS intraoperatively in 25 hospitals in London
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Published in |
Perioperative Medicine, May 2016
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DOI | 10.1186/s13741-016-0036-1 |
Pubmed ID | |
Authors |
Alex Wickham, David Highton, Daniel Martin, The Pan London Perioperative Audit and Research Network (PLAN) |
Abstract |
Anaesthesia is frequently complicated by intraoperative hypotension (IOH) in the elderly, and this is associated with adverse outcome. The definition of IOH is controversial, and although management guidelines for IOH in the elderly exist, the frequency of IOH and typical clinically applied treatment thresholds are largely unknown in the UK. We audited frequency of intraoperative blood pressure against national guidelines in elderly patients undergoing surgery. Depth of anaesthesia (DOA) monitoring was also audited due to the association between low DOA values and IOH with increased mortality (as part of "double" and "triple low" phenomena) and because it is a suggested management strategy to reduce IOH. Twenty-five hospitals submitted data on 481 patients. Hypotension varied depending on the definition, but affected 400 patients (83.3 %) using the AAGBI standard. Furthermore, 2.9, 13.5, and 24.6 % had mean arterial blood pressures <50, <60, and <70 mmHg for 20 min, respectively, and 136 (28.4 %) had systolic blood pressure decrease by 20 % for 20 min. DOA monitors were used for 45 (9.4 %) patients. IOH is common and use of DOA monitors is less than implied by guidelines. Improved management of IOH may be a simple intervention with real potential to reduce morbidity in this vulnerable group. |
X Demographics
Geographical breakdown
Country | Count | As % |
---|---|---|
United Kingdom | 9 | 32% |
United States | 2 | 7% |
Antarctica | 1 | 4% |
Malaysia | 1 | 4% |
Netherlands | 1 | 4% |
Comoros | 1 | 4% |
Australia | 1 | 4% |
Unknown | 12 | 43% |
Demographic breakdown
Type | Count | As % |
---|---|---|
Members of the public | 23 | 82% |
Scientists | 3 | 11% |
Practitioners (doctors, other healthcare professionals) | 2 | 7% |
Mendeley readers
Geographical breakdown
Country | Count | As % |
---|---|---|
United Kingdom | 1 | 2% |
Czechia | 1 | 2% |
Unknown | 39 | 95% |
Demographic breakdown
Readers by professional status | Count | As % |
---|---|---|
Researcher | 6 | 15% |
Student > Doctoral Student | 6 | 15% |
Other | 5 | 12% |
Student > Ph. D. Student | 4 | 10% |
Student > Master | 4 | 10% |
Other | 4 | 10% |
Unknown | 12 | 29% |
Readers by discipline | Count | As % |
---|---|---|
Medicine and Dentistry | 23 | 56% |
Agricultural and Biological Sciences | 2 | 5% |
Nursing and Health Professions | 1 | 2% |
Economics, Econometrics and Finance | 1 | 2% |
Business, Management and Accounting | 1 | 2% |
Other | 0 | 0% |
Unknown | 13 | 32% |