Intraoperative Hypotension and Vasoactive Treatment: An International Survey of Anaesthesiologists.
| Title: | Intraoperative Hypotension and Vasoactive Treatment: An International Survey of Anaesthesiologists. |
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| Authors: | Bækgaard ES; Department of Anaesthesia and Intensive Care, Holbæk Hospital, Holbæk, Denmark.; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.; Vester-Andersen M; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.; Collaboration for Evidence Based Practice and Research in Anaesthesia (CEPRA), Copenhagen, Denmark.; Herlev Anaesthesia Critical and Emergency Care Science Unit, Department of Anaesthesia and Intensive Care, Copenhagen University Hospital - Herlev, University of Copenhagen, Herlev, Denmark.; Crone V; Department of Anaesthesia and Intensive Care, Holbæk Hospital, Holbæk, Denmark.; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.; Møller MH; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.; Department of Intensive Care, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.; Yamanaka S; Department of Anaesthesia, Royal Devon County Hospital, Exeter, UK.; Palmarsdottir R; Department of Anaesthesia and Intensive Care, Holbæk Hospital, Holbæk, Denmark.; Landspítali, National University Hospital Iceland, Reykjavik, Iceland.; Uusalo P; Division of Perioperative Sciences, Intensive Care and Pain Medicine, Turku University Hospital, Turku, Finland.; Haidl F; Anestesiavdelingen, Akershus Universitetssykehus, Lørenskog, Norway.; Rådestad M; Department of Anaesthesia, Karolinska University Hospital, Stockholm, Sweden.; van der Sloot K; Department of Anaesthesiology and Pain Medicine, Groene Hart Ziekenhuis, Gouda, The Netherlands.; Corona A; Department of Anaesthesiology and Intensive Care Medicine, Balgrist University Hospital, Zurich, Switzerland.; Johnström A; Department of Anaesthesiology and Intensive Care, Odense University Hospital, Odense, Denmark.; Nørskov AK; Collaboration for Evidence Based Practice and Research in Anaesthesia (CEPRA), Copenhagen, Denmark.; Department of Anaesthesiology and Intensive Care, Copenhagen University Hospital - North Zealand, Hillerød, Denmark.; Karlsen APH; Collaboration for Evidence Based Practice and Research in Anaesthesia (CEPRA), Copenhagen, Denmark.; Department of Anaesthesia and Intensive Care Medicine, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark.; Faustad BI; Department of Anaesthesiology, Næstved-Slagelse-Ringsted Hospitals, Næstved, Denmark.; Sørensen CB; Department of Anaesthesiology, Sygehus Sønderjylland, Aabenraa, Denmark.; Spies F; Department of Anaesthesia and Surgery South, Aarhus University Hospital, Aarhus, Denmark.; Krogh HB; Department of Anaesthesia and Intensive Care, Regional Hospital Nordjylland, Hjørring, Denmark.; El-Hallak H; Department of Anaesthesiology and Intensive Care, Nykøbing Falster Hospital, Nykøbing Falster, Denmark.; Department of Anaesthesia, Copenhagen University Hospital - Gentofte, Gentofte, Denmark.; Mistry JM; Department of Anaesthesiology and Intensive Care, Sjælland University Hospital, Roskilde, Denmark.; Mønnich JK; Department of Surgery and Intensive Care, Regional Hospital Randers, Randers, Denmark.; Olesen KG; Herlev Anaesthesia Critical and Emergency Care Science Unit, Department of Anaesthesia and Intensive Care, Copenhagen University Hospital - Herlev, University of Copenhagen, Herlev, Denmark.; Madsen KPD; Department of Anaesthesiology, Surgery and Trauma Centre, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.; Voogd KL; Department of Anaesthesiology and Intensive Care, Esbjerg Hospital, Esbjerg, Denmark.; Reich LM; Department of Day Surgery, Copenhagen University Hospital - Amager-Hvidovre, Hvidovre, Denmark.; Kolstrup LA; Department of Cardiothoracic and Vascular Surgery, Anaesthesia Section, Aarhus University Hospital, Aarhus, Denmark.; Juhl-Olsen P; Department of Cardiothoracic and Vascular Surgery, Anaesthesia Section, Aarhus University Hospital, Aarhus, Denmark.; Körner LK; Department of Anaesthesiology and Intensive Care, Aalborg University Hospital, Aalborg, Denmark.; Sigurdsson MI; Landspítali, National University Hospital Iceland, Reykjavik, Iceland.; Jensen-Holm MB; Department of Anaesthesiology and Intensive Care, Regional Hospital Gødstrup, Herning, Denmark.; Slavensky JA; Department of Anaesthesiology, Copenhagen University Hospital - Juliane Marie Center Rigshospitalet, Copenhagen, Denmark.; Toft MH; Department of Anaesthesiology and Intensive Care, Copenhagen University Hospital - Bornholm, Rønne, Denmark.; Jørgensen ML; Department of Anaesthesiology, Sygehus Lillebælt, Vejle, Denmark.; Andersen M; Department of Anaesthesia and Surgery North, Aarhus University Hospital, Aarhus, Denmark.; Jensen MSH; Elective Surgery Centre, Silkeborg Hospital, Silkeborg, Denmark.; Saei M; Department of Anaesthesia, Surgery and Intensive Care, Regional Hospital Horsens, Horsens, Denmark.; Hedetoft M; Department of Anaesthesiology, Surgery and Trauma Centre, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.; Hansen PM; Department of Anaesthesiology and Intensive Care Medicine, Odense University Hospital, Svendborg, Denmark.; Hansen RT; Department of Anaesthesia and Intensive Care, Sygehus Lillebælt, Kolding, Denmark.; Lundsgaard RS; Department of Anaesthesiology, Pain and Respiratory Support, Neuroscience Centre, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.; Krarup SMI; Department of Anaesthesiology and Intensive Care, Sjælland University Hospital, Køge, Denmark.; Wiberg S; Herlev Anaesthesia Critical and Emergency Care Science Unit, Department of Anaesthesia and Intensive Care, Copenhagen University Hospital - Herlev, University of Copenhagen, Herlev, Denmark.; Department of Thoracic Anaesthesiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.; Laustrup T; Department of Anaesthesiology and Intensive Care, Regional Hospital Viborg, Viborg, Denmark.; Brizzi G; Anestesia e Rianimazione CardioToracoVascolare, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy.; Kreutziger J; Department of Anaesthesia and Intensive Care Medicine, Klinik für Anästhesie Und Intensivmedizin, Allgemeine Und Chirurgische Intensivstation, Medical University of Innsbruck, Innsbruck, Austria.; Onyemuchara I; Bolton NHS Foundation Trust, Bolton, UK.; Adeniji A; Countess of Chester Hospital, Countess of Chester NHS Foundation Trust, Chester, UK.; Colville T; Countess of Chester Hospital, Countess of Chester NHS Foundation Trust, Chester, UK.; Keitley JA; Countess of Chester Hospital, Countess of Chester NHS Foundation Trust, Chester, UK.; Khan M; East Lancashire NHS Foundation Trust, Blackburn, UK.; Millar M; Forth Valley Royal Hospital, Larbert, Scotland, UK.; Lennie I; Forth Valley Royal Hospital, Larbert, Scotland, UK.; Kelly K; Liverpool Women's Hospital, Liverpool Women's NHS Trust, Liverpool, UK.; Brooker V; Whiston and St. Helen's Hospital, Mersey and West Lancashire Teaching Hospitals NHS Trust, Prescot, UK.; Roberts J; Whiston and St. Helen's Hospital, Mersey and West Lancashire Teaching Hospitals NHS Trust, Prescot, UK.; Lipton G; Institute for Neurological Sciences, Queen Elizabeth Hospital, NHS Glasgow and Clyde, Glasgow, Scotland, UK.; Keohone J; Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, Glasgow, Scotland, UK.; Chebbout R; Glasgow Royal Infirmary, NHS Glasgow and Clyde, Glasgow, Scotland, UK.; Bond O; University Hospital Wishaw, Wishaw, North Lanarkshire, Scotland, UK.; Milligan W; University Hospital Wishaw, Wishaw, North Lanarkshire, Scotland, UK.; O'Brien C; St John's Hospital, NHS Lothian, Livingston, Scotland, UK.; Wright E; Royal Cornwall Hospitals Trust, Truro, UK.; Linton F; Salisbury Hospitals NHS Trust, Salisbury, UK.; Towell C; Salisbury Hospitals NHS Trust, Salisbury, UK.; Shuttleworth J; Southport and Ormskirk NHS Foundation Trust, Ormskirk, UK.; Norton J; Torbay and South Devon NHS Foundation Trust, Torquay, UK.; Butler D; Torbay and South Devon NHS Foundation Trust, Torquay, UK.; Frankland S; Torbay and South Devon NHS Foundation Trust, Torquay, UK.; Screech F; University Hospitals Plymouth NHS Trust, Plymouth, UK.; Charig L; Bournemouth and Poole Hospitals, University Hospitals Dorset NHS Foundation Trust, Dorset, UK.; Walsh S; Bournemouth and Poole Hospitals, University Hospitals Dorset NHS Foundation Trust, Dorset, UK.; Davies R; Southampton General Hospital, University Hospitals Southampton NHS Foundation Trust, Southampton, UK.; Jones E; Southampton General Hospital, University Hospitals Southampton NHS Foundation Trust, Southampton, UK.; Dalmonte E; Royal Sussex County Hospital, University Hospitals Sussex NHS Foundation Trust, Brighton, UK.; Evans M; Royal Surrey Hospital NHS Foundation Trust, Guildford, UK.; Krag M; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.; Department of Anaesthesiology, Surgery and Trauma Centre, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark. |
| Source: | Acta anaesthesiologica Scandinavica [Acta Anaesthesiol Scand] 2026 Mar; Vol. 70 (3), pp. e70197. |
| Publication Type: | Journal Article |
| Language: | English |
| Journal Info: | Publisher: Wiley-Blackwell Country of Publication: England NLM ID: 0370270 Publication Model: Print Cited Medium: Internet ISSN: 1399-6576 (Electronic) Linking ISSN: 00015172 NLM ISO Abbreviation: Acta Anaesthesiol Scand Subsets: MEDLINE |
| Imprint Name(s): | Publication: Oxford, UK : Wiley-Blackwell; Original Publication: Aarhus, Denmark : Universitetsforlaget, 1957- |
| MeSH Terms: | Hypotension*/drug therapy ; Hypotension*/therapy ; Intraoperative Complications*/drug therapy ; Intraoperative Complications*/therapy ; Vasoconstrictor Agents*/therapeutic use ; Anesthesiologists*; Humans ; Surveys and Questionnaires ; Female ; Male ; Adult ; Middle Aged ; Europe |
| Abstract: | Background: Intraoperative hypotension is a common occurrence in patients undergoing anaesthesia, although there is no standardised definition of hypotension. International consensus statements provide some guidelines for the management of intraoperative hypotension, but general clinical practice is unknown. We aimed to survey anaesthesiologists' values and preferences regarding intraoperative blood pressure management, including whether they would support future research on this topic.; Methods: We conducted an international, online survey of routine practice and opinion. The target population was anaesthesiologists who regularly anaesthetise adult patients. Results are reported descriptively and in accordance with the Consensus-Based Checklist for Reporting of Survey Studies (CROSS) checklist.; Results: A total of 1640 anaesthesiologists from 11 European countries participated in the survey. The majority of respondents were specialists (1322 of 1640, 80.6%, 95% CI 78.7-82.6). Almost all respondents worked in public hospitals (1613 of 1640, 98.4%). The overall response rate was 22.7%. Most respondents reported using absolute mean arterial pressure as their main unit of measurement to quantify hypotension (1098 of 1640, 67.0%, 95% CI 64.6-69.2). Respondents were most likely to initiate vasoactive treatment at a mean arterial pressure below 60 or 65 mmHg. Chronic arterial hypertension, traumatic brain injury and surgical procedures involving head-up positioning of the patient were the three most common scenarios where respondents would raise their threshold for treatment. Most respondents considered the establishment of safe intraoperative blood pressure thresholds a critical research question, and almost all respondents (1509 of 1640, 92.0%) indicated a willingness to randomise patients to specific blood pressure targets. For 72.9% (1196 of 1640), the lowest acceptable mean arterial pressure for randomisation was 60 mmHg. Respondents were also interested in the comparison of efficacy and safety of vasoactive agents, and the most sought-after comparison was phenylephrine versus noradrenaline (1252 of 1640, 76.3%). The willingness of respondents to administer these agents in peripheral venous access differed according to geography.; Conclusion: In this international survey, mean arterial pressures of 60 or 65 mmHg were the most commonly reported blood pressure thresholds leading to initiation of treatment with vasoactive agents. Almost all respondents indicated patient groups for whom they would alter their treatment threshold, namely those suffering from chronic arterial hypertension, those undergoing surgery in a head-up position, and patients with traumatic brain injury. The majority of respondents supported future trials establishing optimal mean arterial pressure threshold and choice of vasoactive agent. We noticed a geographical variation in willingness to administer vasoactive agents in peripheral venous access.; Editorial Comment: This survey of anaesthesiologists from European countries queried practitioner perceptions of blood pressure management in adults during anaesthesia with focus on hypotension. Queries and responses also concerned circumstances and blood pressure levels which clinicians report being willing to treat actively, and how they might do this practically.; (© 2026 Acta Anaesthesiologica Scandinavica Foundation.) |
| References: | J Biomed Inform. 2009 Apr;42(2):377-81. (PMID: 18929686); Anesthesiology. 2020 Mar;132(3):461-475. (PMID: 31794513); Anesthesiology. 2017 Jan;126(1):47-65. (PMID: 27792044); JAMA. 2017 Oct 10;318(14):1346-1357. (PMID: 28973220); Anaesthesia. 2022 Feb;77(2):153-163. (PMID: 34231200); PLoS One. 2015 Aug 03;10(8):e0129305. (PMID: 26237037); J Am Coll Cardiol. 2021 Nov 2;78(18):1753-1764. (PMID: 34711333); Acta Anaesthesiol Scand. 2024 Oct;68(9):1134-1148. (PMID: 38965670); Acta Anaesthesiol Scand. 2026 Mar;70(3):e70197. (PMID: 41633958); JAMA. 2025 Dec 2;334(21):1893-1904. (PMID: 41076588); BMJ Open Ophthalmol. 2023 Jan;8(1):. (PMID: 37278428); Br J Anaesth. 2023 May;130(5):519-527. (PMID: 36925330); Kidney Blood Press Res. 2019;44(2):211-221. (PMID: 30928979); J Gen Intern Med. 2021 Oct;36(10):3179-3187. (PMID: 33886027); Semin Respir Crit Care Med. 2021 Feb;42(1):59-77. (PMID: 32820475); Br J Anaesth. 2015 Dec;115 Suppl 2:ii3-14. (PMID: 26658199); Anesth Analg. 2020 Oct;131(4):1060-1065. (PMID: 32925324); Anesthesiology. 2015 Sep;123(3):515-23. (PMID: 26181335); Br J Anaesth. 2019 May;122(5):563-574. (PMID: 30916004); Anesthesiology. 2007 Aug;107(2):213-20. (PMID: 17667564); Int J Clin Pract. 2021 Nov;75(11):e14570. (PMID: 34165855); BMC Anesthesiol. 2022 Mar 11;22(1):69. (PMID: 35277122); J Anesth Analg Crit Care. 2022 Apr 14;2(1):17. (PMID: 37386537); J Trauma Acute Care Surg. 2018 May;84(5):802-808. (PMID: 29370058); Anesth Analg. 2021 Jun 1;132(6):1654-1665. (PMID: 33177322); JAMA. 2025 Dec 2;334(21):1905-1914. (PMID: 41076587); J Biomed Inform. 2019 Jul;95:103208. (PMID: 31078660); Adv Med Educ Pract. 2020 Aug 25;11:587-599. (PMID: 32904509); J Clin Monit Comput. 2024 Apr;38(2):325-335. (PMID: 38112879); J Clin Anesth. 2017 Dec;43:77-83. (PMID: 29055803); Acta Anaesthesiol Scand. 2023 Jul;67(6):804-810. (PMID: 36922719); J Clin Anesth. 2021 May;69:110150. (PMID: 33418429); BMC Anesthesiol. 2025 Feb 26;25(1):103. (PMID: 40011811); Anesthesiology. 2013 Sep;119(3):507-15. (PMID: 23835589); Br J Anaesth. 2024 Aug;133(2):264-276. (PMID: 38839472); Anesthesiology. 2018 Feb;128(2):317-327. (PMID: 29189290) |
| Grant Information: | Læge Sofus Carl Emil Friis og Hustru Olga Doris Friis' Legat |
| Substance Nomenclature: | 0 (Vasoconstrictor Agents) |
| Entry Date(s): | Date Created: 20260203 Date Completed: 20260203 Latest Revision: 20260504 |
| Update Code: | 20260504 |
| PubMed Central ID: | PMC12895218 |
| DOI: | 10.1111/aas.70197 |
| PMID: | 41633958 |
| Database: | MEDLINE |
Journal Article