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November 23, 1957


JAMA. 1957;165(12):1529-1532. doi:10.1001/jama.1957.02980300009003

Hypotension, defined either as systolic pressure below 90 mm. Hg in an initially normotensive patient or as systolic pressure more than 40 mm. below the preoperative readings in a hypertensive patient, developed in 180 out of 5,463 patients observed in a hospital recovery room. Onset of hypotension could usually be explained as cardiovascular, respiratory, pharmacological, neurogenic, hematologic, or humoral in origin, and consideration of these six possibilities was helpful in deciding on appropriate treatment. Four cases are cited to illustrate, respectively, the possibilities of cardiovascular origin (myocardial infarction during operation), pharmacological origin (cyclopropane and muscle relaxants), neurogenic origin (genitourinary surgery), and humoral origin (interruption of long-continued hormone therapy). In the fourth case recognition of the cause led to the administration of hydrocortisone intravenously with prompt restoration of a normal blood pressure. The authors believe, however, that the most common cause of postoperative hypotension is that group of hematological factors which include transfusion reactions, hemolysis due to distilled water during transurethral resections, and acute or chronic loss of blood.