Background: Anaesthesia is frequently complicated by intraoperative hypotension (IOH) in the elderly, and this is
associated with adverse outcome. The definition of IOH is controversial, and although management guidelines for
IOH in the elderly exist, the frequency of IOH and typical clinically applied treatment thresholds are largely
unknown in the UK.
Methods: We audited frequency of intraoperative blood pressure against national guidelines in elderly patients
undergoing surgery. Depth of anaesthesia (DOA) monitoring was also audited due to the association between low
DOA values and IOH with increased mortality (as part of “double” and “triple low” phenomena) and because it is a
suggested management strategy to reduce IOH.
Results: Twenty-five hospitals submitted data on 481 patients. Hypotension varied depending on the definition,
but affected 400 patients (83.3 %) using the AAGBI standard. Furthermore, 2.9, 13.5, and 24.6 % had mean arterial
blood pressures <50, <60, and <70 mmHg for 20 min, respectively, and 136 (28.4 %) had systolic blood pressure
decrease by 20 % for 20 min. DOA monitors were used for 45 (9.4 %) patients.
Conclusions: IOH is common and use of DOA monitors is less than implied by guidelines. Improved management
of IOH may be a simple intervention with real potential to reduce morbidity in this vulnerable group.