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The human body and its organs require a continuous supply of blood and oxygen. A low blood pressure (hypotension) during surgery can endanger that supply and result in organ ischemia. Continuous monitoring of a patient's blood pressure under general anesthesia is therefore of vital importance to make timely adjustments with cardiovascular medication. Despite this intensive monitoring and treatment, recent scientific evidence suggests that more than 75% of surgical patients have one or more episodes of hypotension, i.e. a mean arterial pressure below 65 mmHg.


A stricter blood pressure management to prevent hypotension is not straightforward. Applying the right drug in an appropriate amount at an appropriate time is surprisingly challenging. In clinical practice, the current paradigm of blood pressure management is predominantly reactive: blood pressure is treated when it approaches the minimally acceptable threshold or when it is rapidly dropping.


From a risk perspective it makes more sense to shift the paradigm to a proactive approach: preemptive use of cardiovascular drugs aims to keep the blood pressure at a safe margin above the minimal acceptable blood pressure threshold. The more risk factors a patient has for intraoperative hypotension, the larger the required margin, and thus the higher the target blood pressure needs to be. This requires a pharmacotherapeutic dosing strategy that allows the anesthesia team to keep their patients’ blood pressures at the appropriate level.


The aim of this adaptive multicenter randomized controlled trial is to implement a pharmacotherapeutic dosing strategy to maintain patients at a target blood pressure level with a sufficient margin from the minimal acceptable blood pressure threshold. This shift from a reactive to a proactive pharmacotherapeutic strategy uses widely-accepted cardiovascular drugs and does not rely on advanced monitoring. The proactive strategy can thus be applied to the large number of surgical patients.

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