Risk factors for hypotension in anaesthetized dogs: a retrospective analysis of 390 cases

[en] Introduction Hypotension during anaesthesia is related to potential adverse outcomes in human and veterinary patients. Careful monitoring of arterial blood pressure during anaesthesia is crucial. This retrospective study aimed at identifying risk factors for hypotension in anaesthetized dogs. Methods Records from general anaesthetics in dogs between October 2023 and April 2024 were reviewed. Data regarding dog signalment, American Society of Anaesthesiologists (ASA) classification, procedure, employed drugs, mechanical ventilation, regional anaesthesia, fluid therapy, duration of anaesthesia, procedures, technique of arterial blood pressure monitoring, were gathered. Primary outcome was the development of hypotension: Mean Arterial Pressure (MAP) ≤ 60 mmHg for at least 3 consecutive measurements 5 min apart. Data were analyzed with descriptive statistics and multivariable logistic regression, the Mann Whitney U test and tests of linearity on continuous variables. Internal validation of the model and power estimation were performed. Results Statistical significance was set at p < 0.05. A total of 390 records were analyzed. Hypotension was present in 72/390 cases (18.5%). An increased Odds Ratio (OR) for hypotension was found with abdominal surgery (overall OR 5.56, 95% CI 2.03–16.00, p = 0.001; abdominal versus (vs) diagnostic OR 5.56, 95% CI 1.33–23.2, p = 0.009; abdominal vs. orthopaedic OR 5.28, 95% CI 1.46–19.1, p = 0.004), age <12 months (overall OR 3.12, 95% CI 1.30–7.42, p = 0.010; young vs. adult OR 3.12, 95% CI 1.11–8.81, p = 0.027) and increasing duration of anaesthesia (OR 1.01, 95% CI 1.00–1.01, p < 0.001). OR for hypotension decreased with higher body mass (OR 0.96, 95% CI 0.94–0.98, p = 0.001), use of regional anaesthesia (overall for epidural-spinal OR 0.14, 95% CI 0.02–0.57, p = 0.014; overall for nerve blocks OR 0.24, 95% CI 0.11–0.50, p < 0.001; epidural-spinal vs. no regional anaesthesia OR 0.14, 95% CI 0.02–0.91, p = 0.036; nerve block vs. no regional anaesthesia OR 0.24, 95% CI 0.09–0.60, p < 0.001), and mechanical ventilation (overall OR 0.52, 95% CI 0.27–0.96, p = 0.039; mechanical ventilation vs. no mechanical ventilation OR 0.52, 95% CI 0.27–0.97, p = 0.039). Discussion Identification of risk factors for hypotension in anaesthetized dogs can contribute to developing prevention and treatment strategies to improve outcomes and safety.

Disciplines :

Veterinary medicine & animal health

Author, co-author :

Mignini, Benedetta ; Université de Liège - ULiège > Fundamental and Applied Research for Animals and Health (FARAH) > FARAH: Médecine vétérinaire comparée

Rives, Albane ; Université de Liège - ULiège > Fundamental and Applied Research for Animals and Health (FARAH) > FARAH: Productions animales durables

Degani, Massimiliano ; Université de Liège - ULiège > Département d'Enseignement et de Clinique des animaux de Compagnie (DCC) > Anesthésiologie et réanimation des animaux de compagnie

Talarico, Chiara ; Université de Liège - ULiège > Département d'Enseignement et de Clinique des animaux de Compagnie (DCC) > Chirurgie des animaux de compagnie

Farnir, Frédéric ; Université de Liège - ULiège > Département de gestion vétérinaire des Ressources Animales (DRA)

Sandersen, Charlotte ; Université de Liège - ULiège > Fundamental and Applied Research for Animals and Health (FARAH) > FARAH: Médecine vétérinaire comparée

Language :

English

Title :

Risk factors for hypotension in anaesthetized dogs: a retrospective analysis of 390 cases

Publication date :

19 June 2026

Journal title :

Frontiers in Veterinary Science

eISSN :

2297-1769

Publisher :

Frontiers Media SA

Volume :

Peer reviewed :

Peer Reviewed verified by ORBi

Additional URL :

https://www.frontiersin.org/articles/10.3389/fvets.2026.1846419/full

Available on ORBi :

since 20 July 2026

Statistics

Number of views

156 (0 by ULiège)

Number of downloads

147 (0 by ULiège)

More statistics

Scopus citations^®

Scopus citations^®
without self-citations

OpenAlex citations

Bibliography

1. Dugdale AHA Beaumont G Bradbrook C Gurney M. "Monitoring animals during general anaesthesia". In: Dugdale AHA Beaumont G Bradbrook C Gurney M, , editors. Veterinary Anaesthesia-Principles to Practice, 2nd Edn. Hoboken: Wiley-Blackwell (2020). p. 281–3.
2. Congdon JM. "Cardiovascular disease". In: Johnson RA Snyder LBC Schroeder CA, , editors. Canine and Feline Anesthesia and Co-Existing Disease, 2nd Edn. Hoboken: Wiley-Blackwell (2022). p. 2–3.
3. Odette O. "Blood pressure monitoring". In: Lamont L Grimm K Robertson S Love L Schroeder C, , editors. Veterinary Anesthesia and Analgesia, 6th Edn. Hoboken: Wiley-Blackwell (2024). p. 198–204.
4. Bijker JB van Klei WA Kappen TH van Wofswinkel L Moons KGM Kalkman CJ. Incidence of intraoperative hypotension as a function of the chosen definition: literature definitions applied to a retrospective cohort using automated data collection. Anesthesiology. (2007) 107:213–20. doi: 10.1097/01.anes.0000270724.40897.8e, 17667564.
5. Vernooij LM van Klei WA Machina M Pasma W Beattie WS Peelen LM. Different methods of modelling intraoperative hypotension and their association with postoperative complications in patients undergoing non-cardiac surgery. Br J Anaesth. (2018) 120:1080–9. doi: 10.1016/j.bja.2018.01.033, 29661385.
6. Weinberg L Li SY Louis M Karp J Poci N Carp BS et al. Reported definitions of intraoperative hypotension in adults undergoing non cardiac surgery under general anaesthesia: a review. BMC Anesthesiol. (2022) 22:69. doi: 10.1186/s12871-022-01605-9, 35277122.
7. Walsh M Devereaux PJ Garg AX Kurz A Turan A Rodseth RN et al. Relationship between intraoperative mean arterial pressure and clinical outcomes after noncardiac surgery: toward an empirical definition of hypotension. Anesthesiology. (2013) 119:507–15. doi: 10.1097/ALN.0b013e3182a10e26, 23835589.
8. Gregory A Stapfelfeldt WH Khanna AK Smischney NJ Boero IJ Chen Q et al. Intraoperative hypotension is associated with adverse clinical outcomes after noncardiac surgery. Anesth Analg. (2021) 132:1654–65. doi: 10.1213/ANE.0000000000005250, 33177322.
9. Wesselink EM Wagemakers SH van Waes JAR Wanderer JP van Klei WA Kappen TH. Associations between intraoperative hypotension, duration of surgery and postoperative myocardial injury after noncardiac surgery: a retrospective single-Centre cohort study. Br J Anaesth. (2022) 129:487–96. doi: 10.1016/j.bja.2022.06.034, 36064492.
10. Oliver JAC Clark L Corletto F Gould DJ. A comparison of anesthetic complications between diabetic and nondiabetic dogs undergoing phacoemulsification cataract surgery: a retrospective study. Vet Ophthalmol. (2010) 13:244–50. doi: 10.1111/j.1463-5224.2010.00793.x, 20618803.
11. Henao-Guerrero N Ricco-Pereira CH Paranjape VV. A comparison of Dobutamine, norepinephrine, vasopressin, and Hetastarch for the treatment of isoflurane-induced hypotension in healthy. Normovolemic Dogs Anim (Basel). (2023) 13:2674. doi: 10.3390/ani13162674, 37627465.
12. Gaynor JS Dunlop CI Wagner AE Wertz EM Golden AE Demme WC. Complications and mortality associated with anesthesia in dogs and cats. J Am Anim Hosp Assoc. (1999) 35:13–7. doi: 10.5326/15473317-35-1-13, 9934922.
13. Redondo JI Rubio M Soler G Serra I Soler C Gómez-Villamandos RJ. Normal values and incidence of cardiorespiratory complications in dogs during general anaesthesia. A review of 1281 cases. J Am Vet Med Assoc. (2007) 54:470–7. doi: 10.1111/j.1439-0442.2007.00987.x, 17931219.
14. Costa RS Raisis A Musk GC Hosgood G. Frequency of hypotension in a historical cohort of anaesthetised dogs undergoing elective desexing. Aust Vet Pract. (2013) 43:414–9.
15. Snowdon KA Smeak DD Chiang S. Risk factors for dehiscence of stapled functional end-to-end intestinal anastomoses in dogs: 53 cases (2001–2012). Vet Surg. (2016) 45:91–9. doi: 10.1111/vsu.12413, 26565990.
16. Itami T Aida H Asakawa M Fujii Y Iizuka T Imai A et al. Association between preoperative characteristics and risk of anaesthesia-related death in dogs in small-animal referral hospitals in Japan. Vet Anaesth Analg. (2017) 44:461–72. doi: 10.1016/j.vaa.2016.08.007.
17. Dixon A Fauber AE. Effect of anesthesia-associated hypotension on neurologic outcome in dogs undergoing hemilaminectomy because of acute, severe thoracolumbar intervertebral disk herniation: 56 cases (2007–2013). J Am Vet Med Assoc. (2017) 250:417–23. doi: 10.2460/javma.250.4.417, 28165305.
18. Hattersley R Downing F Gibson S Demetriou J Elmenhorst K Kulendra N et al. Impact of intra-operative hypotension on mortality rates and post-operative complications in dogs undergoing cholecystectomy. J Small Anim Pract. (2020) 61:624–9. doi: 10.1111/jsap.13199.
19. Miller L Duncan JC Handel IG Shaw DJ McKenzie HE Greenhalgh SN. Association between body mass and hypotension in dogs under general anaesthesia. J Small Anim Pract. (2023) 64:687–95. doi: 10.1111/jsap.13671, 37770103.
20. Ullal TV Jaffey JA Kreisler R Matheson J Pacholec C Shumway K et al. Increasing age and severe intraoperative hypotension associated with nonsurvival in dogs with gallbladder mucocele undergoing cholecystectomy. J Am Vet Med Assoc. (2023) 261:1–9. doi: 10.2460/javma.23.06.0305, 37669748.
21. Ruffato M Novello L Clark L. What is the definition of intraoperative hypotension in dogs? Results from a survey of diplomates of the ACVAA and ECVAA. Vet Anaesth Analg. (2015) 42:55–64. doi: 10.1111/vaa.12169, 24814975.
22. Grimes JA Schmiedt C Cornell KK Radlinsky MAG. Identification of risk factors for septic peritonitis and failure to survive following gastrointestinal surgery in dogs. J Am Vet Med Assoc. (2011) 238:486–94. doi: 10.2460/javma.238.4.486, 21320019.
23. Davis J Rossi G Cianciolo RE Ho KM Hosgood GL Miller DW et al. Early diagnosis of acute kidney injury subsequent to severe hypotension and fluid resuscitation in anaesthetized dogs. Vet Anaesth Analg. (2022) 49:344–53. doi: 10.1016/j.vaa.2022.02.006.
24. Chen BW Davis J Rossi G Hosgood GL Raisis AL. Exploring urinary biomarkers of early acute kidney injury in a clinical model of canine intraoperative hypotension: an observational cohort study. Vet Anaesth Analg. (2025) 52:311–9. doi: 10.1016/j.vaa.2025.02.005, 40187996.
25. Rossmeisl JH White C Pancotto TE Bays A Henao-Guerrero PN. Acute adverse events associated with ventral slot decompression in 546 dogs with cervical intervertebral disc disease. Vet Surg. (2013) 42:795–806. doi: 10.1111/j.1532-950X.2013.12039.x, 23980621.
26. Costa RS Raisis AL Hosgood G Musk GC. Preoperative factors associated with hypotension in young anaesthetised dogs undergoing elective desexing. Aust Vet J. (2015) 93:99–104. doi: 10.1111/avj.12306, 25817974.
27. Le Chevallier D van Oostrom H MacFarlane PD. Evaluation of urine specific gravity as a predictor of hypotension during anaesthesia in healthy dogs premedicated with dexmedetomidine. Vet Anaesth Analg. (2023) 50:289–93. doi: 10.1016/j.vaa.2023.01.001, 37055260.
28. O’Connor AM Sargeant JM Doohoo IR Erb HN Cevallos M Egger M et al. Explanation and elaboration document for the STROBE-vet statement: Strengthening the reporting of observational studies in epidemiology—veterinary extension. J Vet Intern Med. (2016) 30:1896–928. doi: 10.1111/jvim.14592, 27859752.
29. Fédération Cynolgique Internationale Breed Nomenclature. Available online at: https://fci.be/en/Nomenclature/ (Accessed Septemeber 10, 2025).
30. Dziak JJ Dierker LC Abar B. The interpretation of statistical power after the data have been gathered. Curr Psychol. (2021) 39:870–7. doi: 10.1007/s12144-018-0018-1, 32523323.
31. Peduzzi P Concato J Kemper E Holford TR Feinstein A. A simulation study of the number of events per variable in logistic regression analysis. Epidemiol. (1996) 49:1373–9. doi: 10.1016/s0895-4356(96)00236-3.
32. Riley RD Ensor J Snell KI Harrell FE Martin GP Reitsma JB et al. Calculating the sample size required for developing a clinical prediction model. BMJ. (2020) 368:m441. doi: 10.1136/bmj.m441, 32188600.
33. Hodgson PS Liu SS Gras TW. Does epidural anesthesia have general anesthetic effects? A prospective, randomized, double-blind, placebo-controlled trial. Anesthesiology. (1999) 91:1687–92. doi: 10.1097/00000542-199912000-00021, 10598611.
34. Kona-Boun JJ Cuvelliez S Troncy E. Evaluation of epidural administration of morphine or morphine and bupivacaine for postoperative analgesia after premedication with an opioid analgesic and orthopedic surgery in dogs. J Am Vet Med Assoc. (2006) 229:1103–12. doi: 10.2460/javma.229.7.1103, 17014357.
35. Romano M Portela DA Breghi G Otero PE. Stress-related biomarkers in dogs administered regional anaesthesia or fentanyl for analgesia during stifle surgery. Vet Anaesth Analg. (2016) 43:44–54. doi: 10.1111/vaa.12275, 25996102.
36. McMillan MW Seymour CJ Brearley JC. Effect of intratesticular lidocaine on isoflurane requirements in dogs undergoing routine castration. J Small Anim Pract. (2012) 53:393–7. doi: 10.1111/j.1748-5827.2012.01233.x, 22747731.
37. Tsuchiya M. Regional anesthesia: advantages of combined use with general anesthesia and useful tips for improving nerve block technique with ultrasound technology. Curr Topics Anesthesiol. (2017). doi: 10.5772/66573.
38. Grubb T Lobprise H. Local and regional anaesthesia in dogs and cats: overview of concepts and drugs (part 1). Vet Med Sci. (2020) 6:209–17. doi: 10.1002/vms3.219, 31965742.
39. Redondo JI Otero PE Martínez-Taboada F Doménech L Hernández-Magaña EZ Viscasillas J. Anaesthetic mortality in dogs: a worldwide analysis and risk assessment. Vet Rec. (2024) 195:e3604. doi: 10.1002/vetr.3604, 37953683.
40. Luecke T Pelosi P. Clinical review: positive end-expiratory pressure and cardiac output. Crit Care. (2005) 9:607–21. doi: 10.1186/cc3877, 16356246.
41. Kuhn BT Bradley LA Dempsey TM Puro AC Adams JY. Management of Mechanical Ventilation in decompensated heart failure. J Cardiovasc Dev Dis. (2016) 3:33. doi: 10.3390/jcdd3040033, 29367576.
42. Araos J Kenny JES Rousseau-Blass F Pang DS. Dynamic prediction of fluid responsiveness during positive pressure ventilation: a review of the physiology underlying heart-lung interactions and a critical interpretation. Vet Anaesth Analg. (2020) 47:3–14. doi: 10.1016/j.vaa.2019.08.004.
43. Donati PA Tarragona L Cordero IS Franco JVA Liquitay CE Portela DA et al. Diagnostic accuracy of pulse pressure variation, stroke volume variation and plethysmography variability index for prediction of fluid responsiveness in anesthetized and mechanically ventilated dogs: a systematic review and meta-analysis. Vet Anaesth Analg. (2026) 53:101150. doi: 10.1016/j.vaa.2025.10.006.
44. Brodbelt DC Pfeiffer DU Young LE Wood JLN. Results of the confidential enquiry into perioperative small animal fatalities regarding risk factors for anesthetic-related death in dogs. J Am Vet Med Assoc. (2008) 233:1096–104. doi: 10.2460/javma.233.7.1096, 18828720.
45. King LG. Postoperative complications and prognostic indicators in dogs and cats with septic peritonitis: 23 cases (1989-1992). J Am Vet Med Assoc. (1994) 204:407–14. doi: 10.2460/javma.1994.204.03.407.
46. Poulton T Murray D. National Emergency Laparotomy Audit (NELA) project team. Pre-optimisation of patients undergoing emergency laparotomy: a review of best practice. Anaesthesia. (2019) 74:100–7. doi: 10.1111/anae.14514.
47. Strandby RB Osterkamp JTF Ambrus R Henriksen A Goetze JP Secher NH et al. Mesenteric traction syndrome in pigs: a single-blinded, randomized controlled trial. Anim Models Exp Med. (2021) 4:162–8. doi: 10.1002/ame2.12160, 34179723.
48. Olsen AA Bazancir LA Dahl S Fukumori D Shiwaku H Svendsen LB et al. Mesenteric traction syndrome-incidence, impact, and treatment: a systematic scoping review of the literature. Anaesth Crit Care Pain Med. (2023) 42:101162. doi: 10.1016/j.accpm.2022.101162, 36162787.
49. Gozalo-Marcilla M Redondo JI Bettschart-Wolfensberger R Domenech L Doménech J Johnston GM et al. The confidential enquiry into perioperative equine fatalities: phase 4 (CEPEF4) - a worldwide observational, prospective, multicentre cohort study in 2025. Vet Anaesth Analg. (2025) 52:525–38. doi: 10.1016/j.vaa.2025.06.005, 40695694.
50. Magrini F. Haemodynamic determinants of the arterial blood pressure rise during growth in conscious puppies. Cardiovasc Res. (1978) 12:422–8. doi: 10.1093/cvr/12.7.422.