Post-Endarterectomy Blood Pressure Management

Target Blood Pressure Parameters

The British Journal of Anaesthesia recommends maintaining systolic blood pressure between 90-160 mmHg (or within 70-140% of baseline) for patients with normal preoperative baseline blood pressure 1, 2, 3
The British Journal of Anaesthesia suggests keeping mean arterial pressure (MAP) ≥60-65 mmHg to reduce cardiovascular, cerebrovascular, and renal complications 3
For patients with abnormal baseline values, the British Journal of Anaesthesia recommends maintaining systolic pressures >70% of preoperative baseline (or <140% for upper limit) 1, 2, 3

The British Journal of Anaesthesia defines hypotension as systolic BP <100 mmHg (or <75% of baseline, whichever is higher), which requires immediate bedside assessment 1, 2
The British Journal of Anaesthesia states that systolic BP <90 mmHg is associated with increased risk of death, myocardial injury, stroke, and acute kidney injury 4, 5, 6, 7, 8

The British Journal of Anaesthesia recommends increasing monitoring frequency beyond routine 4-6 hour intervals for patients with trending blood pressure changes or requiring tighter control 1, 2
Praxis Medical Insights suggests that continuous blood pressure monitoring is preferred when possible to reduce severity and duration of hypotension 3

Praxis Medical Insights recommends promptly treating MAP <60-65 mmHg or SBP <90 mmHg as prolonged hypotension increases mortality and organ injury 3
The British Journal of Anaesthesia states that avoiding drops >30% below baseline is essential, as this threshold is associated with end-organ injury 4, 6, 7, 8

Praxis Medical Insights suggests transferring to ward when BP remains stable within target ranges 3
Praxis Medical Insights recommends escalating to higher level of care for persistent hypotension or hypertension despite appropriate initial therapies 3

The British Journal of Anaesthesia advises against tolerating prolonged hypotension during sleep, assuming it's physiologic; circadian variations exist but may not justify accepting low pressures without documentation of patient's home baseline 5
The British Journal of Anaesthesia states that patients with preoperative hypertension have higher thresholds for harm than the standard 90 mmHg cutoff 4, 6, 7, 8
Praxis Medical Insights recommends avoiding delaying resumption of ACE inhibitors/ARBs as this increases 30-day mortality risk, but use caution in patients with low perioperative BP 3