Intraoperative hemodynamic reference values for pediatric patients
Instructions
We have estimated reference ranges for blood pressure and heart rate in pediatric patients at two points in the intraoperative period: during the preparation phase (the time at the end of anesthesia induction) and during the surgical phase (15-35 minutes following the start of the procedure). To find the appropriate reference ranges of blood pressure and heart rate values for a child, please first enter the child's sex and chronological age at the time of the procedure. Following that, enter the child's weight (kg) and height (cm). Weight and height values are restricted to the 3rd and 97th percentiles of weight-for-age and stature-for-age centiles from the Centers for Disease Control and Prevention (CDC): https://www.cdc.gov/growthcharts/cdc-data-files.htm.
Reference ranges are only applicable to children born at term, classified as ASA Physical Status 1 or 2, undergoing a non-emergency procedure with general anesthesia.
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Website developed by: Christopher J. Butler
Accompanying: Virginia E. Tangel, Jurgen C. de Graaff, Viviane G. Nasr, Robert Jan Stolker, Christopher J. Butler, Kane O. Pryor, Sten Willemsen, Sanne E. Hoeks, for the Multicenter Perioperative Outcomes Group (MPOG) Perioperative Clinical Research Committee (PCRC).
Reference values and web-based tool for intraoperative heart rate and blood pressure in paediatric patients undergoing general anaesthesia for noncardiac procedures. doi: https://doi.org/10.1016/j.bja.2026.09.024
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Interactive 3D surfaces. Select an outcome, then rotate, zoom, and pan to explore. Click the "Arrow" icon next to an outcome name to download the raw data.
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Abstract
Background: Heart rate (HR) and blood pressure (BP) monitoring is standard of care during pediatric anesthesia, yet evidence-based reference values for anesthetized children remain limited. Existing BP reference values do not account for the combined effects of age, sex, weight, and height; and HR reference values in this population are lacking.
Methods: We conducted a retrospective multicenter study using data from the Multicenter Perioperative Outcomes Group anesthesia registry (2016-2022). Included patients were aged <18 years, ASA Physical Status 1 or 2, undergoing non-cardiac procedures under general anesthesia. We used quantile regression to model the 2.3rd, 16th, 50th, 84th, and 97.7th centiles for HR, mean arterial pressure, systolic BP, and diastolic BP at two stable time points: the preparation phase (end of anesthesia induction) and surgical phase (15-35 minutes after procedure start). We selected the best model for each outcome using 5-fold cross-validation with pinball loss. Predictions were restricted to biologically plausible covariate combinations using established pediatric reference ranges.
Results: A total of 284,385 cases from 57 institutions were analyzed. Optimal model complexity varied by outcome: A two-way interaction model was selected as the best-performing model for two of the eight outcomes (preparation HR and surgical MAP). A three-way interaction model was selected as the best-performing model for the remaining six outcomes. Comprehensive prediction tables and an interactive web-based tool were developed for all eight outcomes.
Conclusions: This study provides integrated HR and BP reference values for healthy pediatric patients undergoing general anesthesia, incorporating age, sex, weight, and height simultaneously. These reference values with an interactive website may support clinical decision-making and hemodynamic monitoring in pediatric patients.
Disclaimer:
The website accompanying the publication 'Reference values and web-based tool for intraoperative heart rate and blood pressure in paediatric patients undergoing general anaesthesia for non-cardiac procedures' (“Information”) is offered for educational and information purposes only and is not meant as a substitute for independent medical judgment or the advice of a qualified physician or healthcare professional. The Information is not intended to provide professional or medical advice or recommend any particular technique, medical device or service, including recommendations or endorsements. Users who choose to use the information or recommendations made available by accessing the information do so at their own risk. To the maximum extent permitted by applicable law, we will not be liable due to the temporary inability to consult this website, for any third party content linked to our website or which we refer to on our website, including, but not limited to, any inaccuracies, errors or omission in any content, any intellectual property infringement, or any loss or damage of any kind incurred as a result of the use of any third party content linked in or otherwise made available via the website.