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International Angiology 2021 Sep 22

DOI: 10.23736/S0392-9590.21.04679-4


language: English

Defining the awake baseline blood pressure in patients undergoing carotid endarterectomy

Leonie M. FASSAERT 1, Julia F. HEUSDENS 2, Saskia HAITJEMA 3, Imo E. HOEFER 3, Wouter W. van SOLINGE 3, Leo van WOLFSWINKEL 2, Jilles B. BIJKER 4, Rogier V. IMMINK 5, Gert J. de BORST 1

1 Department of Vascular Surgery, G04.129, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands; 2 Department of Anaesthesiology, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands; 3 Departments of Clinical Chemistry and Haematology, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands; 4 Department of Anaesthesiology, Gelderse Vallei Hospital, Ede, The Netherlands; 5 Department of Anaesthesiology, Academic Medical Centre Amsterdam, Amsterdam, The Netherlands


BACKGROUND: To minimize the incidence of intraoperative stroke following carotid endarterectomy (CEA) under general anaesthesia, blood pressure (BP) is suggested to be maintained between ‘awake baseline’ BP and 20% above. However, there is neither a widely accepted protocol nor a definition to determine this awake BP. In this study, we analysed the BP during hospital admission in the days before CEA and propose a definition of how to determine awake BP.
METHODS: In our cohort of 1180 CEA-patients, all non-invasive BP-measurements were retrospectively analysed. BP was measured during preoperative outpatient screening (POS), the last three days before surgery at the ward and in the operating room(OR) directly before anaesthesia. Primary outcome was the comparability of all these preoperative BP measurements. Secondary outcome was the comparability of preoperative BP measurements stratified for postoperative stroke within 30 days.
RESULTS: POS BP [148±22/80±12mmHg(mean arterial pressure(MAP)103±14mmHg)] and the BP measured on the ward 3,2,1 days before surgery and on the day of surgery [146±25/77±13(MAP 100±15)], [142±23/76±13(MAP 98±15)], [145±23/76±12(MAP 99±14)] and [144±22/75±12mmHg(MAP 98±14)] were comparable (all p=NS). However, BP in the OR directly before anaesthesia was higher, [163±27/88±15mmHg(MAP 117±18mmHg)] (p<0.01 vs all other preoperative moments). A significant higher pre-induction systolic BP and MAP was observed in patients suffering a stroke within 30-days compared to patients without (p=0.03 and 0.04 respectively).
CONCLUSIONS: Awake BP should be determined by averaging available BP-values collected preoperatively on the ward and POS. BP measured in the OR directly before induction of anaesthesia overestimates ‘awake’ BP and should therefore not be used.

KEY WORDS: Anesthesia; Blood pressure; Blood pressure determination; Preoperative; Carotid endarterectomy; Stroke prevention

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