Perioperative management of blood pressure in neurocritical patients: Consensus reached through the Delphi method

Abstract

Elaboration of a consensus document to address perioperative blood pressure (BP) in neurocritical patients, made with anesthesia and resuscitation, and intensive medicine specialists in Spain, by means of a modified Delphi methodology in two rounds with a questionnaire answered by 65 panelists. Consensus was reached in 126 (74.6 %) of 169 statements, with 113 agreements (66.9 %). Consensus was obtained for the use of clevidipine, urapidil, and beta-blockers for acute hypertension in head trauma patients and for brain tumor surgery, among others. The experts considered that the existing clinical studies evaluating the optimal perioperative therapy in neurocritical patients with altered BP are insufficient and that most recommendations are based on clinical experience. Therefore, treatment must be individualized regardless of absolute BP target value and based on occurrence/absence of acute organ damage and the coexistence of other diseases.