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Cohen B, Rivas E, Pu X, et al. Diurnal blood pressure variation in adults after abdominal surgery-An observational cohort study. J Clin Anesth. 2021;77:110633doi: 10.1016/j.jclinane.2021.110633.
Cohen, B., Rivas, E., Pu, X., Maheshwari, K., Araujo-Duran, J. A., Turan, O., Volio, A., Yalcin, E. K., & Turan, A. (2021). Diurnal blood pressure variation in adults after abdominal surgery-An observational cohort study. Journal of clinical anesthesia, 77110633. https://doi.org/10.1016/j.jclinane.2021.110633
Cohen, Barak, et al. "Diurnal blood pressure variation in adults after abdominal surgery-An observational cohort study." Journal of clinical anesthesia vol. 77 (2021): 110633. doi: https://doi.org/10.1016/j.jclinane.2021.110633
Cohen B, Rivas E, Pu X, Maheshwari K, Araujo-Duran JA, Turan O, Volio A, Yalcin EK, Turan A. Diurnal blood pressure variation in adults after abdominal surgery-An observational cohort study. J Clin Anesth. 2021 Dec 24;77:110633. doi: 10.1016/j.jclinane.2021.110633. Epub 2021 Dec 24. PMID: 34959083.
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J Clin Anesth. 2021 Dec 24;77:110633. doi: 10.1016/j.jclinane.2021.110633. Epub 2021 Dec 24.

Diurnal blood pressure variation in adults after abdominal surgery-An observational cohort study.

Journal of clinical anesthesia

Barak Cohen, Eva Rivas, Xuan Pu, Kamal Maheshwari, Jorge A Araujo-Duran, Oguz Turan, Andrew Volio, Esra Kutlu Yalcin, Alparslan Turan

Affiliations

  1. Department of Outcomes Research, Cleveland Clinic, Cleveland, OH, United States; Division of Anesthesia, Intensive Care, and Pain Management, Tel-Aviv Sourasky Medical Center, Tel-Aviv University, Tel-Aviv, Israel.
  2. Department of Outcomes Research, Cleveland Clinic, Cleveland, OH, United States; Department of Anesthesia, Hospital Clinic of Barcelona, IDIBAPS, Universidad de Barcelona, Barcelona, Spain.
  3. Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, United States.
  4. Department of Outcomes Research, Cleveland Clinic, Cleveland, OH, United States; Department of General Anesthesiology, Cleveland Clinic, Cleveland, OH, United States.
  5. Department of Outcomes Research, Cleveland Clinic, Cleveland, OH, United States.
  6. Department of Outcomes Research, Cleveland Clinic, Cleveland, OH, United States; Department of General Anesthesiology, Cleveland Clinic, Cleveland, OH, United States. Electronic address: [email protected].

PMID: 34959083 DOI: 10.1016/j.jclinane.2021.110633

Abstract

OBJECTIVE: To describe the prevalence of various circadian blood pressure patterns in adults recovering from abdominal surgery, and to evaluate the association between loss of normal circadian variation in blood pressure and hypotension during the initial 2 postoperative days.

DESIGN: A post-hoc analysis of data obtained from two randomized trials.

SETTING: Operating rooms of the Cleveland Clinic.

PATIENTS: Adults having abdominal surgery from 2015 to 2019 with at least one overnight stay. Participants were continuously monitored by wearable vital signs monitors starting in the post-anesthesia care unit and for the first 48 postoperative hours.

INTERVENTIONS: None. The exposure of interest was the degree of nocturnal decrease in blood pressure - normal nocturnal decrease in blood pressure ("normal dipping", more than 10% decrease compared to day-time), no nocturnal decrease ("non-dipping", less than 10% nocturnal decrease), or nocturnal increase in blood pressure ("rising").

MEASUREMENTS: Postoperative hypotension, defined by the time weighted average (TWA) area under a mean arterial pressure (MAP) threshold of 70 mmHg.

RESULTS: In total, 590 patients were eligible for analysis (mean(SD) age 50(15) years, 56% females, median [IQR] surgery duration 4.0 [2.7, 5.8] hours). Median TWA area under a MAP threshold of 70 mmHg was 0.96 (95%CI 0.59, 1.33) mmHg*minute per monitoring hour lower in patients with either no nocturnal blood pressure decrease (N = 317, 54%), or an increase in nocturnal blood pressure (N = 211, 36%), than in the reference group of patients with normal nocturnal decrease (N = 62, 11%), P < 0.001 for both.

CONCLUSIONS: Abnormal diurnal blood pressure patterns are common in adults during the initial 2 days after abdominal surgery. Lack of normal night-time decrease in blood pressure is associated with less postoperative hypotension. Future studies should evaluate whether abnormal postoperative diurnal blood pressure patterns are associated with worse outcomes.

Copyright © 2021 Elsevier Inc. All rights reserved.

Keywords: Arterial blood pressure; Circadian rhythm; Diurnal rhythm; Postoperative period

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