Fluid responsiveness and hypotension in patients undergoing propofol-based sedation for colonoscopy following bowel preparation: a prospective cohort study.

IF 3.4 3区医学 Q1 ANESTHESIOLOGY

Canadian Journal of Anesthesia-Journal Canadien D Anesthesie Pub Date : 2025-04-01 Epub Date: 2025-04-11 DOI:10.1007/s12630-025-02939-x

Megan L Allen, Michael Kluger, Frank Schneider, Kaylee Jordan, John Xie, Kate Leslie

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引用次数: 0

Abstract

Purpose: Fasting and bowel preparation may deplete intravascular volume in patients undergoing colonoscopy. Nevertheless, rigorous demonstration of volume depletion and assessment of clinical consequences is lacking. We designed this study to explore the relationship between intravascular volume status and intraprocedural hypotension and to compare transthoracic echocardiography (TTE) and the ClearSight™ (Edwards Lifesciences, Irvine, CA, USA) noninvasive cardiac output monitor to measure intravascular volume status.

Methods: We recruited adult patients undergoing elective colonoscopy following bowel preparation at the Royal Melbourne Hospital. We assessed the volume status preprocedure by taking TTE and ClearSight measurements in patients in the semirecumbent position and following passive leg raising. Patients received propofol-based sedation, and significant intraprocedural hypotension was defined as a mean arterial pressure (MAP) < 60 mm Hg. The primary outcome was the occurrence of intravascular volume depletion as assessed by a positive result in a passive leg raise test on TTE (a 15% increase in the subaortic velocity time integral).

Results: Ninety-nine patients completed the study. The primary outcome was recorded in 29 of the 90 patients with adequate TTE images (32%; 95% confidence interval, 23 to 43). There was inadequate agreement between average TTE and ClearSight measurements of stroke volume at baseline or after passive leg raising. More patients experienced significant intraprocedural hypotension in the fluid-responsive group (48%) than in the normovolemic group (21%).

Conclusion: Patients undergoing elective colonoscopy after bowel preparation were often fluid responsive. These patients were more likely to have significant intraprocedural hypotension than patients who were volume replete. Transthoracic echocardiography assessment of volume status cannot be readily replaced by ClearSight monitoring.

Study registration: ANZCTR.org.au ( ACTRN12616000614493 ); first registered 11 May 2016.

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肠准备后接受异丙酚镇静结肠镜检查患者的液体反应性和低血压：一项前瞻性队列研究

目的：在接受结肠镜检查的患者中，禁食和肠道准备可能会消耗血管内容量。然而，缺乏体积损耗的严格证明和临床后果的评估。我们设计了这项研究来探讨血管内容量状态与术中低血压之间的关系，并比较经胸超声心动图（TTE）和ClearSight™（Edwards Lifesciences, Irvine， CA， USA）无创心输出量监测仪来测量血管内容量状态。方法：我们招募了在皇家墨尔本医院进行肠道准备后接受选择性结肠镜检查的成年患者。我们通过对处于半卧位和被动抬腿的患者进行TTE和ClearSight测量来评估术前容积状态。患者接受基于异丙酚的镇静治疗，术中明显低血压被定义为平均动脉压（MAP）。结果：99名患者完成了研究。90例患者中有29例(32%；95%置信区间为23 ~ 43)。基线时或被动抬腿后平均TTE和ClearSight测量的脑卒中容积之间的一致性不足。液体反应组出现明显术中低血压的患者（48%）多于等容量组（21%）。结论：在肠准备后接受择期结肠镜检查的患者通常有液体反应。这些患者比容量充足的患者更容易出现明显的术中低血压。经胸超声心动图对容积状态的评估不能轻易地被ClearSight监测所取代。研究注册：ANZCTR.org.au (ACTRN12616000614493)；首次注册于2016年5月11日。

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来源期刊

Canadian Journal of Anesthesia-Journal Canadien D Anesthesie 医学-麻醉学

CiteScore

8.50

自引率

7.10%

发文量

161

审稿时长

6-12 weeks

期刊介绍： The Canadian Journal of Anesthesia (the Journal) is owned by the Canadian Anesthesiologists’ Society and is published by Springer Science + Business Media, LLM (New York). From the first year of publication in 1954, the international exposure of the Journal has broadened considerably, with articles now received from over 50 countries. The Journal is published monthly, and has an impact Factor (mean journal citation frequency) of 2.127 (in 2012). Article types consist of invited editorials, reports of original investigations (clinical and basic sciences articles), case reports/case series, review articles, systematic reviews, accredited continuing professional development (CPD) modules, and Letters to the Editor. The editorial content, according to the mission statement, spans the fields of anesthesia, acute and chronic pain, perioperative medicine and critical care. In addition, the Journal publishes practice guidelines and standards articles relevant to clinicians. Articles are published either in English or in French, according to the language of submission.