Questions · Intraoperative Hypotension
10 questions, 0 approved. Approve them one at a time — a quiz shows nothing you have not.
Recall — derived from a kept point
Summarise the mean arterial pressure thresholds and exposure durations at which organ injury has been reported in the systematic review literature on intraoperative hypotension: what is reported below a MAP of 80 mmHg, below 70 mmHg, and below 55-50 mmHg?
Answer: Organ injury is reported after 10 minutes or more below a MAP of 80 mmHg, after shorter periods below 70 mmHg, and at any exposure below 55-50 mmHg.
There is no single hypotension number - the lower the pressure, the shorter the exposure that has been linked to injury.
Source claim: Organ injury is reported after 10 minutes or more below a mean arterial pressure of 80 mmHg, after shorter periods below 70 mmHg, and at any exposure below 55-50 mmHg.
Intraoperative Hypotension and the Risk of Postoperative Adverse Outcomes: A Systematic Review, British journal of anaesthesia 2018
recall · CA-1 · phrased by llm
You are escalating a norepinephrine infusion to hold a MAP target during noncardiac surgery. State what a retrospective cohort analysis found about cumulative intraoperative norepinephrine dose and postoperative acute kidney injury, and what that implies about the trade-off you are making.
Answer: Cumulative intraoperative norepinephrine dose was independently associated with postoperative acute kidney injury in that retrospective cohort. It is an association rather than proven causation, but it means escalating vasopressor to chase a pressure target is not a risk-free trade.
Both sides of the equation carry risk - the low pressure you are treating and the drug you are treating it with.
Source claim: Cumulative intraoperative norepinephrine dose is independently associated with postoperative acute kidney injury, so escalating vasopressor to chase a pressure target is not a risk-free trade.
Association of Intraoperative Hypotension and Cumulative Norepinephrine Dose With Postoperative Acute Kidney Injury in Patients Having Noncardiac Surgery: A Retrospective Cohort Analysis, British journal of anaesthesia 2025
recall · CA-2 · phrased by llm
In a prospective international multicentre cohort study of noncardiac surgery, which combination of intraoperative vital-sign extremes showed a stronger association with myocardial injury than low systolic pressure alone? Name both components with their thresholds.
Answer: A maximum intraoperative heart rate above 100 bpm together with a minimum systolic pressure below 100 mmHg. That combination was more strongly associated with myocardial injury than low systolic pressure alone - an association reported from a prospective cohort.
Read the heart rate next to the pressure - tachycardia with a low systolic carried a stronger association with myocardial injury than the low pressure by itself.
Source claim: A maximum intraoperative heart rate above 100 bpm together with a minimum systolic pressure below 100 mmHg is more strongly associated with myocardial injury than low systolic pressure alone.
A Prospective International Multicentre Cohort Study of Intraoperative Heart Rate and Systolic Blood Pressure and Myocardial Injury After Noncardiac Surgery: Results of the VISION Study, Anesthesia and analgesia 2018
recall · CA-2 · phrased by llm
Patients were randomised to an intraoperative MAP target of at least 75 mmHg versus 60 mmHg. Describe what the higher target achieved in terms of hypotension exposure and what it did not achieve in terms of clinical outcomes, then say what this implies about treating time-below-threshold as a surrogate endpoint.
Answer: The higher target cut time spent below 65 mmHg by roughly 60%, but did not reduce acute myocardial injury or 30-day major cardiac events and acute kidney injury. Reducing the hypotension exposure did not carry the clinical outcomes with it, so time-below-threshold behaved as a surrogate that moved on its own.
You can successfully move the number you are targeting and still not move the outcome you actually care about.
Source claim: Targeting a MAP of at least 75 mmHg instead of 60 mmHg cut time spent below 65 mmHg by roughly 60% but did not reduce acute myocardial injury or 30-day major cardiac events and acute kidney injury.
Targeting Higher Intraoperative Blood Pressures Does Not Reduce Adverse Cardiovascular Events Following Noncardiac Surgery, Journal of the American College of Cardiology 2021
recall · CA-3 · phrased by llm
Mean arterial pressures below ___-70 mmHg are associated with myocardial injury, acute kidney injury and death, and the injury is a function of both how far the pressure falls and how long it stays there.
Answer: 60
Mean arterial pressures below 60-70 mmHg are associated with myocardial injury, acute kidney injury and death, and the injury is a function of both how far the pressure falls and how long it stays there.
Perioperative Quality Initiative Consensus Statement on Intraoperative Blood Pressure, Risk and Outcomes for Elective Surgery · PMID 30916004
recall · CA-2 · phrased by derived
Hypotension on the four days after surgery carried a far stronger association with myocardial infarction and death (odds ratio 2.83) than each extra ___ minutes of intraoperative hypotension (odds ratio 1.08).
Answer: 10
Hypotension on the four days after surgery carried a far stronger association with myocardial infarction and death (odds ratio 2.83) than each extra 10 minutes of intraoperative hypotension (odds ratio 1.08).
Period-Dependent Associations Between Hypotension During and for Four Days After Noncardiac Surgery and a Composite of Myocardial Infarction and Death: A Substudy of the POISE-2 Trial · PMID 29189290
recall · CA-2 · phrased by derived
The point with one number taken out. No model wrote any of this: the stem is the sentence you reviewed, minus a digit, and the paper it came from is named beneath it.
Open prompts
How does your plan change if the patient is not optimised?
open · CA-2 · phrased by derived
What is the physiology behind what we just did?
open · CA-2 · phrased by derived
Talk me through the trade-off you made there.
open · CA-2 · phrased by derived
What would make you abandon this plan and do something else?
open · CA-2 · phrased by derived
Questions only — nothing here asserts anything, which is why a model is allowed to phrase them. Where no model was reachable these are the level defaults.