Association between mean arterial pressure and sublingual microcirculation during major non‐cardiac surgery: Post hoc analysis of a prospective cohort

Author:

Laou Eleni1,Papagiannakis Nikolaos2ORCID,Michou Anastasia3,Ntalarizou Nicoleta3,Ragias Dimitrios3,Angelopoulou Zacharoula3,Sessler Daniel I.4,Chalkias Athanasios35ORCID

Affiliation:

1. Department of Anesthesiology Agia Sophia Children's Hospital Athens Greece

2. First Department of Neurology, Eginition University Hospital, Medical School National and Kapodistrian University of Athens Athens Greece

3. Department of Anesthesiology, Faculty of Medicine University of Thessaly Larisa Greece

4. Department of Outcomes Research Cleveland Clinic Cleveland Ohio USA

5. Outcomes Research Consortium Cleveland Ohio USA

Abstract

AbstractObjectiveTo test the hypothesis that there is an association between mean arterial pressure (MAP) and sublingual perfusion during major surgery, and perhaps an identifiable harm threshold.MethodsThis post hoc analysis of a prospective cohort included patients who had elective major non‐cardiac surgery with a duration of ≥2 h under general anesthesia. We assessed sublingual microcirculation every 30 min using SDF+ imaging and determined the De Backer score, Consensus Proportion of Perfused Vessels (Consensus PPV), and the Consensus PPV (small). Our primary outcome was the relationship between MAP and sublingual perfusion which was evaluated with linear mixed effects modeling.ResultsA total of 100 patients were included, with MAP ranging between 65 mmHg and 120 mmHg during anesthesia and surgery. Over a range of intraoperative MAPs between 65 and 120 mmHg, there were no meaningful associations between blood pressure and various measures of sublingual perfusion. There were also no meaningful changes in microcirculatory flow over 4.5 h of surgery.ConclusionsIn patients having elective major non‐cardiac surgery with general anesthesia, sublingual microcirculation is well maintained when MAP ranges between 65 and 120 mmHg. It remains possible that sublingual perfusion will be a useful marker of tissue perfusion when MAP is lower than 65 mmHg.

Publisher

Wiley

Subject

Physiology (medical),Cardiology and Cardiovascular Medicine,Molecular Biology,Physiology

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