Sustained intraoperative hypotension (SIH) during shoulder arthroscopy was independently associated with PONV, with SIH patients exhibiting significantly higher severity grades for both nausea and vomiting.
PONV occurred in nearly one-third of patients who underwent shoulder arthroscopy.
Sustained intraoperative hypotension (SIH) was independently associated with the occurrence of PONV.
Female sex was independently associated with increased odds of PONV following shoulder arthroscopy.
Smoking was independently associated with decreased odds of PONV following shoulder arthroscopy.
A history of motion sickness and/or PONV was the strongest independent predictor of PONV in this cohort.
Patients with SIH had significantly higher severity grades for both nausea and vomiting compared to non-SIH patients.
This research suggests that when blood pressure is kept deliberately low during shoulder arthroscopy (a common surgical technique to reduce bleeding and improve visibility), maintaining that low blood pressure for an extended period — specifically, a drop of at least 20% from the patient's normal level lasting 60 minutes or more — is linked to a significantly higher chance of experiencing nausea and vomiting after surgery. In this study of 306 patients, about 31% experienced postoperative nausea and vomiting (PONV), and those who experienced prolonged low blood pressure during surgery were more than twice as likely to develop PONV compared to those who did not. They also tended to have more severe nausea and vomiting. Other factors that independently predicted PONV included being female (nearly four times the odds), having a prior history of motion sickness or PONV (over 32 times the odds), and smoking, which was associated with lower odds of PONV. These findings are consistent with established PONV risk factors, but the study adds sustained intraoperative hypotension as a newly characterized independent contributor in the specific context of shoulder arthroscopy. This research suggests that careful management of intraoperative blood pressure — avoiding prolonged periods of very low pressure — may be a modifiable factor in reducing PONV after shoulder arthroscopy. Clinicians could potentially use the presence of sustained hypotension during surgery as an additional signal to anticipate and preemptively treat PONV in the postoperative period. Because this was a retrospective study, further prospective research would be needed to confirm these findings and determine whether interventions targeting intraoperative blood pressure actually reduce PONV rates.
Yu R, Yang X, Chen J, Zhang F. (2026). Sustained hypotension during shoulder arthroscopy is associated with postoperative nausea and vomiting.. PloS one. https://doi.org/10.1371/journal.pone.0357794