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In anesthesia, one of our greatest responsibilities is protecting patients from preventable harm during surgery. As the Anesthesia Patient Safety Foundation reminds us, “No patient shall be harmed by anesthesia.” That guiding principle remains at the heart of our work—and continues to drive innovation across the perioperative space. Through the use of advanced monitoring and evidence-based protocols, we are continually evolving our practice to significantly minimize the risk of post-surgical complications, so that patients can rest assured they are in expert hands.
The transition from basic tools to intelligent systems in anesthesia has transformed how we manage patient care. As Moon and Cannesson describe in Anesthesia & Analgesia, the field has progressed from “the Tool” to “the Machine,” and now toward automation, with much of our monitoring enhanced by digital platforms and software-driven interoperability. As our clinical tools and evidence base evolve, so does our ability to recognize and reduce risk—particularly when it comes to intraoperative hypotension (IOH).
IOH remains a key contributor to a range of postoperative complications, including acute kidney injury, cardiac events, surgical site infections (SSI), postoperative cognitive dysfunction (POCD), and delayed recovery. Importantly, IOH is often preventable and increasingly recognized as a modifiable intraoperative factor.
Recent literature—including studies I’ve contributed to alongside Dr. Wael Saasouh, Dr. Tim Ward, Steven Garvin, CRNA, and Anna Middleton, CRNA—reinforces the value of early identification of IOH and proactive, evidence-based goal-directed hemodynamic strategies. These approaches emphasize early risk identification, continuous advanced monitoring, and timely intervention—representing a shift from reactive to anticipatory care. Importantly, the conversation is evolving beyond IOH alone to encompass a broader understanding of hemodynamic instability, which reflects a more comprehensive range of perfusion-related risks that can influence patient outcomes.
While research continues to refine best practices, one message is clear: minimizing IOH and managing overall hemodynamic instability improves patient safety, supports faster recoveries, and may help reduce downstream complications and healthcare costs. A recent collaborative publication in Spine found that the presence of intraoperative hypotension was more strongly associated with complications than traditional factors like surgical time, ASA classification, or estimated blood loss—with cost savings estimated at approximately $2,500 per case, making this both a clinical and economic priority.
In anesthesia care, our dedication to quality, innovation, and patient-centered excellence drives us to continually evolve our practices. Comprehensive monitoring and hemodynamic precision are just two examples of how we’re studying new ways to improve care to continually lead the way in advancing surgical safety and outcomes.
1. Moon JS, Cannesson M. A Century of Technology in Anesthesia & Analgesia. Anesth Analg. 2022;135(2S Suppl 1):S48–S61.
2. Glassman SD, Carreon LY, Chappell DL, et al. Association Between Intraoperative Hypotension and Postoperative Complications Following Lumbar Fusion. Spine (Phila Pa 1976). 2024 Mar 15;49(6):433–440.
3. Glassman SD, Carreon LY, Chappell DL, et al. Intraoperative Hypotension and Surgical Site Infection in Lumbar Fusion. Spine (Phila Pa 1976). 2024 Jun 1;49(11):813–819.
4. Glassman SD, Carreon LY, Chappell DL, et al. Intraoperative Hypotension and Risk of Complications in Staged Spine Surgery. Spine (Phila Pa 1976). 2025 Jan 1;50(1):12–19.
