198 🩺 Periop. Blood Pressure Mgmt.: From the 2019 POQI Consensus to the 2024 Update & VISION Studies

🩸 Is an intraoperative MAP of 65 mmHg really a safe threshold? Death from anesthesia is now rare, yet mortality within 30 days after surgery remains far higher than intraoperative mortality. Perioperative hypotension and myocardial injury after noncardiac surgery (MINS) sit at the center of this problem. 📘 In 2019, the Perioperative Quality Initiative (POQI-3) published consensus statements in the BJA that systematically addressed preoperative, intraoperative, and postoperative blood pressure management. In 2024, POQI XI updated these recommendations based on new randomized trials and emerging evidence. 🔄 In this Special Topic lecture, we compare the 2019 and 2024 consensus statements side by side and explain exactly what changed. We cover the recommendation to keep MAP ≥60 mmHg, adjusting targets for elevated venous or compartment pressure, cause-based treatment of hypotension, continuous arterial pressure monitoring, and why postoperative hypotension may matter even more. 🔬 We also take a deep dive into the VISION cohort analyses that underpin the consensus. These include preoperative heart rate, intraoperative heart rate and systolic blood pressure, and the relationship between coronary artery disease burden on coronary CT angiography and perioperative hypotension. 📚 What this video covers An overview of POQI and the modified Delphi method 2019 preoperative consensus: baseline blood pressure, deferral of surgery, ACEI/ARB and beta blocker management 2019 intraoperative consensus: MAP 60 to 70 mmHg, SBP 100 mmHg, and cardiac surgery thresholds 2019 postoperative consensus: SBP 90 mmHg, ward monitoring, and structured bedside assessment The 2024 POQI XI update: what is new and what has changed Key trials including POISE-3 and INPRESS and how to interpret them Open research questions: Hypotension Prediction Index, closed-loop systems, and vasopressor choice VISION study: preoperative heart rate and MINS VISION study: intraoperative heart rate, systolic blood pressure, and MINS Coronary CTA VISION: coronary disease burden and perioperative hypotension 💡 Clinicians will take away a practical checklist for the operating room and the ward. Researchers will gain a clear view of which studies are needed next and how to design them. 🎓 Recommended for medical students, anesthesiology residents and specialists, and perioperative medicine researchers. #PerioperativeBloodPressure #POQI #ConsensusStatement #BJA #IntraoperativeHypotension #PostoperativeHypotension #MINS #VISIONStudy #Anesthesiology #PerioperativeMedicine #POISE3 #ArterialPressure #Hemodynamics #HypotensionPredictionIndex #MedicalEducation #ResidentEducation #AnesthesiaResearch #SpecialTopic