Abstract
Hypotension requires treatment when organ perfusion is inadequate or at risk. The threshold for intervention is therefore dependent on a number of elements, including the patient's vascular status and the causative factors. Hypotension is caused by either a reduction in systemic vascular resistance or a decrease in cardiac output, which in itself can be due to inadequate stroke volume or abnormal rate or rhythm. The causes of these changes are discussed in the framework of patient, anaesthetic and surgical factors. A general clinical approach to diagnosis and management is discussed. The context of the situation needs to be immediately assessed, and will usually lead to a rapid determination of the cause. A more structured approach is required in the case of refractory hypotension where the cause is not obvious or the response to treatment is inadequate.
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