Introduction
cancer mass reduction, blood loss, IOH, hypotension, organ injury, postoperative organ dysfunction, Hypotension
BLOOD LOSS, EVENT, EDWARDS
Intraoperative hypotension (IOH) represents a common event during noncardiac surgery and has been associated with worse postoperative outcomes [The use of cardiac output (CO) monitoring to guide administration of intravenous fluid and inotropic drugs as part of a hemodynamic therapy algorithm has been shown to improve tissue perfusion and oxygenation [The multicentric INPRESS randomized controlled trial (RCT) demonstrated that applying an individualized blood pressure target to be achieved with norepinephrine infusion in addition to a GDT reduces postoperative organ dysfunction, suggesting that using a target approach to minimize IOH would reduce organ injury [Despite careful hemodynamic monitoring and protocols for vasopressor and fluid administration, accurate control of MAP remains a challenge [It is difficult to predict IOH. Current treatment is often initiated when hypotension is already manifest, and anaesthesiologists only react to it. An algorithm developed using machine learning techniques and based on the arterial pressure waveform analysis, named Hypotension Prediction Index (HPI, Edwards Lifesciences, Irvine, USA), has been recently developed [Major gynaecologic oncologic surgery for cancer mass reduction is often associated with unstable hemodynamics and significant blood loss [The primary aim of this single-centre RCT was to compare the cumulative amount of IOH (defined as a MAP value below 65 mmHg) in 2 groups of patients undergoing major gynaecologic oncologic surgery managed using a GDT protocol aimed to optimize cardiac output or the HPI hemodynamic guidance combined to a different GDT protocol. Secondly, we compared IOH during the first 20 min after induction of GA and the amount of severe hypotension in the 2 groups. In addition, we also tested the threshold of 50 mmHg for IOH.