Effect of predictive prevention algorithm based on HPI versus conventional PPV based hemodynamic management on intraoperative hypotension in surgeries for intracranial space occupying lesions: A randomized controlled trial

Intraoperative hypotension is one of the commonest adverse events in neurosurgery. It is associated with increased mortality and morbidity in the postoperative period such as cerebral infarction. Incidence of intraoperative hypotension varies from 5% - 99%. The causes for IOH during neurosurgery include anaesthetic drugs, uncorrected hypovolemia, pre-existing co – morbidities, use of osmotherapy, bleeding and surgical manipulation. The Hypotension Prediction Index (HPI) represents a pioneering advancement in hemodynamic monitoring, anticipating intraoperative hypotensive episodes before they occur. Through a sophisticated software algorithm, HPI evaluates data collected by invasive blood pressure monitoring sensors, providing early insights into the factors contributing to impending hypotension and guiding timely interventions to address hemodynamic instability. Given the strong association between hypotension and postoperative complications, including increased risks of myocardial infarction, cerebrovascular incidents, and prolonged hospital stays, it is conceivable that timely and appropriate interventions by anaesthesiologists could mitigate such damage. These interventions aim to reduce both the frequency and duration of intraoperative hypotension, potentially leading to improved patient outcomes.