Intra-operative haemodynamic monitoring and management of adults having noncardiac surgery
This article was developed by a diverse group of 25 international experts from the European Society of Anaesthesiology and Intensive Care (ESAIC), who formulated recommendations on intra-operative haemodynamic monitoring and management of adults having noncardiac surgery based on a review of the current evidence. We recommend basing intra-operative arterial pressure management on mean arterial pressure and keeping intra-operative mean arterial pressure above 60 mmHg. We further recommend identifying the underlying causes of intra-operative hypotension and addressing them appropriately. We suggest pragmatically treating bradycardia or tachycardia when it leads to profound hypotension or likely results in reduced cardiac output, oxygen delivery or organ perfusion. We suggest monitoring stroke volume or cardiac output in patients with high baseline risk for complications or in patients having high-risk surgery to assess the haemodynamic status and the haemodynamic response to therapeutic interventions. However, we recommend not routinely maximising stroke volume or cardiac output in patients having noncardiac surgery. Instead, we suggest defining stroke volume and cardiac output targets individually for each patient considering the clinical situation and clinical and metabolic signs of tissue perfusion and oxygenation. We recommend not giving fluids simply because a patient is fluid responsive but only if there are clinical or metabolic signs of hypovolaemia or tissue hypoperfusion. We suggest monitoring and optimising the depth of anaesthesia to titrate doses of anaesthetic drugs and reduce their side effects.
Authors
- Jacques Duranteau (ORCID: https://orcid.org/0000-0003-1902-2624)
- Bettina Jungwirth (ORCID: https://orcid.org/0000-0001-9749-7460)
- Michelle S. Chew (ORCID: https://orcid.org/0000-0003-2888-4111)
- Giovanna Lurati Buse (ORCID: https://orcid.org/0000-0002-8076-5737)
- Wolfgang Bühre (ORCID: https://orcid.org/0000-0002-8296-9426)
- Bernard Cholley (ORCID: https://orcid.org/0000-0001-6388-6011)
- Moritz Flick (ORCID: https://orcid.org/0000-0003-4415-9956)
- Stefan De Hert (ORCID: https://orcid.org/0000-0002-6624-1646)
- Alexander Zarbock (ORCID: https://orcid.org/0000-0002-2124-1714)
- Agnes S. Meidert (ORCID: https://orcid.org/0000-0002-5212-9071)
- Alexandre Joosten (ORCID: https://orcid.org/0000-0002-5214-4589)
- Mark Coburn (ORCID: https://orcid.org/0000-0002-7930-0270)
- Michael Sander (ORCID: https://orcid.org/0000-0003-1677-3609)
- Kristen K Thomsen (ORCID: https://orcid.org/0000-0001-9187-9724)
- Karim Kouz (ORCID: https://orcid.org/0000-0001-8107-6952)
- Carolina Soledad Romero (ORCID: https://orcid.org/0000-0002-2325-4463)
- Dan Longrois (ORCID: https://orcid.org/0000-0001-5864-8975)
- Jaap Jan Vos (ORCID: https://orcid.org/0000-0002-0597-6462)
- Fabio Guarracino (ORCID: https://orcid.org/0000-0002-2562-0199)
- Steffen Rex (ORCID: https://orcid.org/0000-0002-3536-9321)
- Barak Cohen (ORCID: https://orcid.org/0000-0001-7417-444X)
- Jean-Luc Fellahi
- Bernd Saugel (ORCID: https://orcid.org/0000-0002-2378-1976)
- Stefano Romagnoli (ORCID: https://orcid.org/0000-0001-8391-6142)
Institutions
- Université Claude Bernard Lyon 1 (FR)
- Universität Hamburg (DE)
- Université Paris Cité (FR)
- Université Paris-Saclay (FR)
- Düsseldorf University Hospital (DE)
- Integrated Cardio Metabolic Centre (SE)
- University Medical Center Hamburg-Eppendorf (DE)
- Heinrich Heine University Düsseldorf (DE)
- Ludwig-Maximilians-Universität München (DE)
Publication Details
- Journal
- European Journal of Anaesthesiology
- Published
- 2025-05-01
- DOI
- https://doi.org/10.1097/eja.0000000000002174
- Citations
- 30
- Primary Topic
- Hemodynamic Monitoring and Therapy
- Type
- article
- Field-Weighted Citation Impact
- 60.19