Hypotension during non-cardiac surgery is associated with myocardial injury, acute kidney injury, cerebral infarction and death; therefore, different mean arterial pressure thresholds have been set for various surgeries. We will determine why the results and treatment plans of thoracic surgery cannot be applied to other diseases of the chest easily, especially in cases of one-lung ventilation (OLV). Thoracic anaesthesia is a type of intrapulmonary shunt that causes hypoxic pulmonary vasoconstriction (HPV) and redistribution of pulmonary blood flow. Lateral positioning, conditions of the thoracic chamber and lung artery obstruction all increase the afterload of the right ventricle (RV), and the time to administer fluid is short. The mean arterial pressure should be less than 60 - 65 mmHg; if it is still this low or even lower, further investigation and treatment will be necessary. Monitor blood pressure, right ventricular (RV) function, pulmonary vascular resistance (PVR), oxygenation, airway pressure, haemorrhage and fluid responsiveness. Although the non-thoracic data have biological significance, random studies in the chest should be carried out before setting general blood pressure goals or haemodynamic models.
References
[1]
Sessleribb D.I., Bloomstone, J.A., Aronson, S., Berry, C., Gan, T.J., Kellum, J.A., et al. (2019) Perioperative Quality Initiative Consensus Statement on Intraoperative Blood Pressure, Risk and Outcomes for Elective Surgery. BritishJournalofAnaesthesia, 122, 563-574. https://doi.org/10.1016/j.bja.2019.01.013
[2]
Wesselink, E.M., Kappen, T.H., Torn, H.M., Slooter, A.J.C. and van Klei, W.A. (2018) Intraoperative Hypotension and the Risk of Postoperative Adverse Outcomes: A Systematic Review. BritishJournalofAnaesthesia, 121, 706-721. https://doi.org/10.1016/j.bja.2018.04.036
[3]
Futier, E., Lefrant, J., Guinot, P., Godet, T., Lorne, E., Cuvillon, P., et al. (2017) Effect of Individualized vs Standard Blood Pressure Management Strategies on Postoperative Organ Dysfunction among High-Risk Patients Undergoing Major Surgery. JAMA, 318, 1346-1357. https://doi.org/10.1001/jama.2017.14172
[4]
Marcucci, M., Painter, T.W., Conen, D., Lomivorotov, V., Sessler, D.I., Chan, M.T.V., et al. (2023) Hypotension-Avoidance versus Hypertension-Avoidance Strategies in Noncardiac Surgery: An International Randomized Controlled Trial. AnnalsofInternalMedicine, 176, 605-614. https://doi.org/10.7326/m22-3157
[5]
Pearse, R.M., Harrison, D.A., MacDonald, N., Gillies, M.A., Blunt, M., Ackland, G., et al. (2014) Effect of a Perioperative, Cardiac Output-Guided Hemodynamic Therapy Algorithm on Outcomes Following Major Gastrointestinal Surgery: A Randomized Clinical Trial and Systematic Review. JAMA, 311, 2181-2190. https://doi.org/10.1001/jama.2014.5305
[6]
Marongiu, I., Spinelli, E. and Mauri, T. (2020) Cardio-Respiratory Physiology during One-Lung Ventilation: Complex Interactions in Need of Advanced Monitoring. AnnalsofTranslationalMedicine, 8, Article No. 524. https://doi.org/10.21037/atm.2020.03.179
[7]
Shelley, B., Glass, A., Keast, T., McErlane, J., Hughes, C., Lafferty, B., et al. (2023) Perioperative Cardiovascular Pathophysiology in Patients Undergoing Lung Resection Surgery: A Narrative Review. BritishJournalofAnaesthesia, 130, e66-e79. https://doi.org/10.1016/j.bja.2022.06.035
[8]
Lumb, A.B. and Slinger, P. (2015) Hypoxic Pulmonary Vasoconstriction: Physiology and Anesthetic Significance. Anesthesiology, 122, 932-946. https://doi.org/10.1097/aln.0000000000000569
[9]
Licker, M., Hagerman, A., Jeleff, A., Schorer, R. and Ellenberger, C. (2021) The Hypoxic Pulmonary Vasoconstriction: From Physiology to Clinical Application in Thoracic Surgery. SaudiJournalofAnaesthesia, 15, 250-263. https://doi.org/10.4103/sja.sja_1216_20
[10]
Haddad, F., Doyle, R., Murphy, D.J. and Hunt, S.A. (2008) Right Ventricular Function in Cardiovascular Disease, Part II: Pathophysiology, Clinical Significance and Treatment of Right Ventricular Failure. Circulation, 117, 1717-1731. https://doi.org/10.1161/circulationaha.107.653584
[11]
Humbert, M., Kovacs, G., Hoeper, M.M., Badagliacca, R., Berger, R.M.F., Brida, M., et al. (2022) 2022 ESC/ERS Guidelines for the Diagnosis and Treatment of Pulmonary Hypertension. 2022 ESC/ERS Guidelines. EuropeanHeartJournal, 43, 3618-3731. https://doi.org/10.1093/eurheartj/ehac237
[12]
Levin, A.I., Coetzee, J.F. and Coetzee, A. (2008) Arterial Oxygenation and One-Lung Anesthesia. CurrentOpinioninAnaesthesiology, 21, 28-36. https://doi.org/10.1097/aco.0b013e3282f2bb79
[13]
Batchelor, T.J.P., Rasburn, N.J., Abdelnour-Berchtold, E., Brunelli, A., Cerfolio, R.J., Gonzalez, M., et al. (2018) Guidelines for Enhanced Recovery after Lung Surgery: Recommendations of the Enhanced Recovery after Surgery (ERAS？) Society and the European Society of Thoracic Surgeons (ESTS). EuropeanJournalofCardio-ThoracicSurgery, 55, 91-115. https://doi.org/10.1093/ejcts/ezy301
[14]
Wittenstein, J., ？entürk, N.M., Kiss, T., Schultz, M.J., Serpa Neto, A., Gama de Abreu, M., et al. (2026) Effects of Intraoperative Higher versus Lower Positive End-Expiratory Pressure during One-Lung Ventilation for Thoracic Surgery on Postoperative Pulmonary Complications (PROTHOR): A Multicentre, International, Randomised, Controlled, Phase 3 Trial. TheLancetRespiratoryMedicine, 14, 17-28. https://doi.org/10.1016/s2213-2600(25)00330-3
[15]
Pintaric, T.S., Potocnik, I., Hadzic, A., Stupnik, T., Pintaric, M. and Jankovic, V.N. (2011) Comparison of Continuous Thoracic Epidural with Paravertebral Block on Perioperative Analgesia and Hemodynamic Stability in Patients Having Open Lung Surgery. RegionalAnesthesiaandPainMedicine, 36, 256-260. https://doi.org/10.1097/aap.0b013e3182176f42
[16]
Huang, W.W., Zhu, W.Z., Mu, D.L., Ji, X., Li, X., Ma, D., et al. (2020) Intraoperative Hypotension Is Associated with Shortened Overall Survival after Lung Cancer Surgery. BMCAnesthesiology, 20, Article No. 160. https://doi.org/10.1186/s12871-020-01062-2
Vernooij, L.M., van Klei, W.A., Machina, M., Pasma, W., Beattie, W.S. and Peelen, L.M. (2018) Different Methods of Modelling Intraoperative Hypotension and Their Association with Postoperative Complications in Patients Undergoing Non-Cardiac Surgery. BritishJournalofAnaesthesia, 120, 1080-1089. https://doi.org/10.1016/j.bja.2018.01.033
[19]
Salmasi, V., Maheshwari, K., Yang, D., Mascha, E.J., Singh, A., Sessler, D.I., et al. (2017) Relationship between Intraoperative Hypotension, Defined by Either Reduction from Baseline or Absolute Thresholds, and Acute Kidney and Myocardial Injury after Noncardiac Surgery: A Retrospective Cohort Study. Anesthesiology, 126, 47-65. https://doi.org/10.1097/aln.0000000000001432
[20]
Güldner, A., Kiss, T., Serpa Neto, A., Hemmes, S.N.T., Canet, J., Spieth, P.M., et al. (2015) Intraoperative Protective Mechanical Ventilation for Prevention of Postoperative Pulmonary Complications: A Review of the Effects of Tidal Volume, Positive End-Expiratory Pressure and Lung Recruitment Maneuvers. Anesthesiology, 123, 692-713. https://doi.org/10.1097/aln.0000000000000754
[21]
The PROVE Network Investigators for the Clinical Trial Network of the European Society of Anaesthesiology (2014) High versus Low Positive End-Expiratory Pressure during General Anaesthesia for Open Abdominal Surgery (PROVHILO Trial): A Multicentre Randomised Controlled Trial. The Lancet, 384, 495-503. https://doi.org/10.1016/S0140-6736(14)60416-5
[22]
Park, M., Ahn, H.J., Kim, J.A., Yang, M., Heo, B.Y., Choi, J.W., et al. (2019) Driving Pressure during Thoracic Surgery: A Randomized Controlled Trial. Anesthesiology, 130, 385-393. https://doi.org/10.1097/aln.0000000000002600
[23]
Ferrando, C., Carrami？ana, A., Pi？eiro, P., Mirabella, L., Spadaro, S., Librero, J., et al. (2024) Individualised, Perioperative Open-Lung Ventilation Strategy during One-Lung Ventilation (iPROVE-OLV): A Multicentre, Randomised, Controlled Clinical Trial. TheLancetRespiratoryMedicine, 12, 195-206. https://doi.org/10.1016/s2213-2600(23)00346-6
[24]
Piccioni, F., Langiano, N., Bignami, E., Guarnieri, M., Proto, P., D’Andrea, R., et al. (2023) One-Lung Ventilation and Postoperative Pulmonary Complications after Major Lung Resection Surgery. A Multicenter Randomized Controlled Trial. JournalofCardiothoracicandVascularAnesthesia, 37, 2561-2571. https://doi.org/10.1053/j.jvca.2023.04.029
[25]
Zorrilla-Vaca, A., Barbeta, E., Librero, J. and Ferrando, C. (2025) Open-Lung Ventilation and Mechanical Power in Thoracic Surgery: Post Hoc Analysis of a Multicentre Randomised Trial. EuropeanJournalofAnaesthesiology, 43, 395-404. https://doi.org/10.1097/eja.0000000000002271
[26]
Ahn, H.J., Kim, J.A., Lee, A.R., Yang, M., Jung, H.J. and Heo, B. (2016) The Risk of Acute Kidney Injury from Fluid Restriction and Hydroxyethyl Starch in Thoracic Surgery. Anesthesia&Analgesia, 122, 186-193. https://doi.org/10.1213/ane.0000000000000974
[27]
Lei, S.H., Guo, G.F., Yan, T., Zhao, B., Qiu, S. and Liu, K. (2023) Acute Kidney Injury after General Thoracic Surgery: A Systematic Review and Meta-Analysis. JournalofSurgicalResearch, 287, 72-81. https://doi.org/10.1016/j.jss.2023.01.011
[28]
Myles, P.S., Bellomo, R., Corcoran, T., Forbes, A., Peyton, P., Story, D., et al. (2018) Restrictive versus Liberal Fluid Therapy for Major Abdominal Surgery. NewEnglandJournalofMedicine, 378, 2263-2274. https://doi.org/10.1056/nejmoa1801601
[29]
Li, M. and Peng, M. (2021) Prospective Comparison of the Effects of Intraoperative Goal-Directed Fluid Therapy and Restrictive Fluid Therapy on Complications in Thoracoscopic Lobectomy. Journal of International Medical Research, 49, 1-8. https://doi.org/10.1177/03000605211062787
[30]
Cecconi, M., De Backer, D., Antonelli, M., Beale, R., Bakker, J., Hofer, C., et al. (2014) Consensus on Circulatory Shock and Hemodynamic Monitoring. Task Force of the European Society of Intensive Care Medicine. IntensiveCareMedicine, 40, 1795-1815. https://doi.org/10.1007/s00134-014-3525-z
[31]
Maheshwari, K., Khanna, S., Bajracharya, G.R., Makarova, N., Riter, Q., Raza, S., et al. (2018) A Randomized Trial of Continuous Noninvasive Blood Pressure Monitoring during Noncardiac Surgery. Anesthesia&Analgesia, 127, 424-431. https://doi.org/10.1213/ane.0000000000003482
[32]
Liem, V.G.B., Hoeks, S.E., Mol, K.H.J.M., Potters, J.W., Grüne, F., Stolker, R.J., et al. (2020) Postoperative Hypotension after Noncardiac Surgery and the Association with Myocardial Injury. Anesthesiology, 133, 510-522. https://doi.org/10.1097/aln.0000000000003368
[33]
McEvoy, M.D., Gupta, R., Koepke, E.J., Feldheiser, A., Michard, F., Levett, D., et al. (2019) Perioperative Quality Initiative Consensus Statement on Postoperative Blood Pressure, Risk and Outcomes for Elective Surgery. BritishJournalofAnaesthesia, 122, 575-586. https://doi.org/10.1016/j.bja.2019.01.019.
