The influence of anesthetic drug strategy on the incidence of post induction hypotension in elective, non-cardiac surgery – A prospective observational cohort study

IF 5 2区医学 Q1 ANESTHESIOLOGY

Journal of Clinical Anesthesia Pub Date : 2024-10-28 DOI:10.1016/j.jclinane.2024.111671

Lotte E. Terwindt MD , Johan T.M. Tol MD , Ward H. van der Ven MD , Vincent C. Kurucz MD , Sijm H. Noteboom MSc , Jennifer S. Breel MSc , Björn J.P. van der Ster PhD , Eline Kho PhD , Rogier V. Immink MD, PhD , Jimmy Schenk PhD , Alexander P.J. Vlaar MD, PhD , Markus W. Hollmann MD, PhD , Denise P. Veelo MD, PhD

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引用次数: 0

Abstract

Study objectives

To identify the influence of modifiable factors in anesthesia induction strategy on post-induction hypotension (PIH), specifically the type, dosage and speed of administration of induction agents. A secondary aim was to identify patient related non-modifiable factors associated with PIH.

Design

Single-center, prospective observational cohort study.

Setting

Operating room.

Patients

Adult, ASA I-IV patients undergoing elective, non-cardiac surgery under general anesthesia (GA).

Interventions

None.

Measurements

Continuous non-invasive blood pressure using finger-cuff technology. PIH was defined as mean arterial pressure (MAP) <65 mmHg ≥1 min, and, separately, as a > 30 % decrease from baseline MAP ≥1 min.

Main results

Study measurements were performed in 760 patients, of which 720 were suitable for analysis. A total of 238 patients (33.1 %) experienced PIH according to the 65 mmHg threshold, and 287 (39.9 %) using the 30 % decrease in MAP threshold. Remifentanil administration was associated with increased risk of PIH according to either definition (MAP <65 mmHg: OR 1.88, 95 %CI 1.31–2.69, p < 0.001, 30 % MAP decrease: OR 1.66, 95 %CI 1.15–2.40, p = 0.007). Pre-emptive vasopressor use (before or during first minute of GA) was associated with reduced risk of PIH (MAP <65 mmHg: OR 0.65, 95 %CI 0.45–0.95, p = 0.027, MAP 30 % decrease: OR 0.58, 95 %CI 0.40–0.84, p = 0.004). Speed of propofol bolus administration, propofol bolus dose, and esketamine use were not associated with PIH in multivariable analysis. Propofol bolus dose decreased with increasing age and American Society of Anesthesiologists physical status classification.

Conclusions

PIH was common in this patient cohort, regardless of the definition used. Two of the five examined modifiable factors were associated with PIH: remifentanil infusion was associated with an increased risk, and pre-emptive vasopressor use was associated with a decreased risk of PIH. No association between propofol dose and PIH was found, most likely due dose adjustment based on clinical assessment rather than a true absence of effect.

Clinical registration number

This study was registered in the Dutch Medical Research in Humans (OMON) register on 18 June 2019 (ID: NL7810). The study was approved by the Medical Ethics Committee of the Amsterdam UMC, location AMC, the Netherlands in December 2018 (NL 6748.018.18; 2018).

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麻醉药物策略对择期非心脏手术诱导后低血压发生率的影响--前瞻性观察队列研究

研究目的确定麻醉诱导策略中的可调节因素对诱导后低血压（PIH）的影响，特别是诱导剂的类型、剂量和给药速度。设计单中心、前瞻性观察性队列研究.设置手术室.患者在全身麻醉（GA）下接受择期非心脏手术的 ASA I-IV 级成人患者.干预措施无.测量使用指套技术进行连续无创血压测量。PIH定义为平均动脉压（MAP）<65 mmHg ≥1分钟，另外，定义为平均动脉压（MAP）>从基线MAP下降30% ≥1分钟。根据 65 mmHg 临界值，共有 238 名患者（33.1%）出现 PIH，根据 MAP 下降 30% 临界值，共有 287 名患者（39.9%）出现 PIH。无论采用哪种定义，使用雷米芬太尼都会增加 PIH 的风险（MAP <65 mmHg：OR 1.88, 95 %CI 1.31-2.69, p < 0.001，MAP 下降 30 %：OR 1.66，95 %CI 1.15-2.40，p = 0.007）。抢先使用血管加压剂（在 GA 开始前或第一分钟内）与 PIH 风险降低有关（MAP 为 65 mmHg，OR 为 0.65，95 %CI 为 1.15-2.40，p = 0.007）：OR 0.65, 95 %CI 0.45-0.95, p = 0.027，MAP 下降 30 %：OR 0.58, 95 %CI 0.40-0.84, p = 0.004）。在多变量分析中，异丙酚栓剂给药速度、异丙酚栓剂剂量和埃斯卡敏的使用与 PIH 无关。丙泊酚栓剂剂量随年龄和美国麻醉医师协会身体状况分类的增加而减少。在所研究的五个可改变因素中，有两个与 PIH 有关：瑞芬太尼输注与 PIH 风险增加有关，而预先使用血管加压剂与 PIH 风险降低有关。本研究于2019年6月18日在荷兰人类医学研究（OMON）注册（ID：NL7810）。该研究于2018年12月获得荷兰阿姆斯特丹UMC所在地AMC医学伦理委员会的批准（NL 6748.018.18；2018）。

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来源期刊

Journal of Clinical Anesthesia 医学-麻醉学

CiteScore

7.40

自引率

4.50%

发文量

346

审稿时长

23 days

期刊介绍： The Journal of Clinical Anesthesia (JCA) addresses all aspects of anesthesia practice, including anesthetic administration, pharmacokinetics, preoperative and postoperative considerations, coexisting disease and other complicating factors, cost issues, and similar concerns anesthesiologists contend with daily. Exceptionally high standards of presentation and accuracy are maintained. The core of the journal is original contributions on subjects relevant to clinical practice, and rigorously peer-reviewed. Highly respected international experts have joined together to form the Editorial Board, sharing their years of experience and clinical expertise. Specialized section editors cover the various subspecialties within the field. To keep your practical clinical skills current, the journal bridges the gap between the laboratory and the clinical practice of anesthesiology and critical care to clarify how new insights can improve daily practice.