All intraoperative hypotension is not created equal - Position the sixth phenotype

• Published in: Journal of clinical anesthesia Vol. 88; p. 111128
• Main Authors: Diego, Escarraman Martínez, Guerrero Gutiérrez Manuel, A., Solís-Pérez Gerardo, A., Antolinez-Mota Jorge, M., Arturo, Vázquez Peralta, Elizalde, Herrera Rafael
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-09-2023; Elsevier Limited
• Subjects: Abdomen; Blood; Compression therapy; Genotype & phenotype; Hemodynamics; Hipotension; Humans; Hypotension; Hypotension - diagnosis; Hypotension - etiology; Intraoperative; Intraoperative Complications - etiology; Intraoperative Complications - prevention & control; Patients; Positions; Risk Factors; Positions; Intraoperative; Hipotension
• ISSN: 0952-8180; 1873-4529
• DOI: 10.1016/j.jclinane.2023.111128

Patients in a sitting position present with a significant accumulation of blood volume in the lower extremities, which causes a decrease in their venous return, the recumbent position also have a great impact on the venous return of the lower extremities, mainly in the flexed right lateral decubitus position, due to the compression of the inferior vena cava causes displacement of abdominal visors, which also increases the resistance to venous return and accumulation of blood volume in the lower extremities, resulting in a reduction in the so-called “stressed volume”, while the prone position causes an increase in intra-abdominal pressure secondary to the inadequate distribution of body weight, compromising both, the hemodynamic and respiratory responses, intra-abdominal hypertension compresses the inferior vena cava and reduces venous return together with the hemodynamic reserve of the right ventricle [2]. [...]a subtle repositioning of the patient is recommended, perhaps by changing the angle of the bed and the patient without modifying the position too much, and elevating the extremities in case hypotension has already occurred. At some point, the literature describes preload with volume, but this can lead to congestion due to the time lapse of the procedure. [...]it is crucial to emphasize preventive measures that promote venous return and avoid resorting to correcting this phenotype to a great extent by administering intravenous volume. [...]there is sufficient evidence to suggest the position of patients during surgery is responsible for increasing the risk of perioperative hypotension, making it the sixth phenotype.Authors contributions Writing-original draft: EMDDisclosure statement This research did not receive any specific grant from funding agencies in the. public, commercial, or not-for-profit sectors.Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.