Post-induction hypotension is common in older patients, those on renin–angiotensin blockers or diuretics, the dehydrated and the frail. Its timing — the minutes after induction, before surgical stimulation — is predictable.
Established measures include reviewing whether to omit ACE inhibitors or angiotensin receptor blockers on the morning of surgery according to local policy, limiting prolonged fasting from clear fluids, titrating induction doses in older patients, and having a vasopressor drawn up before induction. Holding mean arterial pressure at 65 mmHg or above remains the standard target.
- Have a vasopressor drawn up and ready before inducing older or high-risk patients.
- Reduce and titrate induction doses in older and frail patients.
- Follow local policy on omitting ACE inhibitors and ARBs on the day of surgery.
- Encourage clear fluids up to two hours before surgery where fasting rules allow.
Why it matters
Preventing the predictable dip is easier than chasing it.
Read the rest in the app
You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this finding is waiting in it.
Scan to keep reading on your phone. No account needed to start.
Tomorrow morning, before your first patient
One edition a day for anaesthesiology, written by the desk, every claim tied to its paper. Six minutes.
Get the app — free