Hemodynamic stability refers to the maintenance of adequate blood circulation and perfusion pressure to vital organs, particularly the brain, heart, and kidneys. It is a critical parameter during perioperative care, critical illness, and trauma resuscitation.

Hemodynamic status is typically assessed by monitoring:

• Blood pressure (BP): systolic, diastolic, mean arterial pressure (MAP)
• Heart rate (HR) and rhythm
• Cardiac output (CO) and stroke volume (SV)
• Central venous pressure (CVP)
• Peripheral perfusion: capillary refill, skin temperature, lactate
• Urine output: indirect marker of renal perfusion

• Stable: Adequate BP (MAP ≥ 65 mmHg), normal HR, good perfusion signs
• Unstable: Hypotension (MAP < 60–65 mmHg), tachycardia or bradycardia, signs of hypoperfusion (oliguria, confusion, mottling)

• Hypovolemia: hemorrhage, dehydration
• Cardiogenic: myocardial infarction, arrhythmias
• Distributive: sepsis, anaphylaxis
• Obstructive: tension pneumothorax, cardiac tamponade, pulmonary embolism

• Guides fluid therapy, vasopressor/inotrope use, and monitoring strategies
• Essential for safe anesthesia and surgical outcomes
• Unstable hemodynamics increase risk of organ failure, stroke, or death

• Fluids: crystalloids, colloids, blood products
• Vasopressors: norepinephrine, phenylephrine, vasopressin
• Inotropes: dobutamine, epinephrine
• Monitoring: invasive BP, arterial line, echocardiography, advanced hemodynamic devices (e.g. PiCCO, FloTrac)

In neurosurgical patients:

• Sudden increases in BP may raise intracranial pressure (ICP)
• Scalp block or adequate analgesia helps maintain stability during craniotomy
• Hypotension should be avoided to preserve cerebral perfusion pressure (CPP = MAP - ICP)