Prevention of hypotension after neuraxial anesthesia in nonobstetric surgery: a systematic review.

IF 3.4 3区医学 Q1 ANESTHESIOLOGY

Canadian Journal of Anesthesia-Journal Canadien D Anesthesie Pub Date : 2025-04-17 DOI:10.1007/s12630-025-02925-3

Sandra Lee, Nehal Islam, Karim S Ladha, Mark C Bicket, Duminda N Wijeysundera

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引用次数: 0

Abstract

Purpose: Hypotension occurs frequently during neuraxial anesthesia and is associated with increased risks of perioperative complications. We sought to conduct a systematic review and meta-analysis of randomized controlled trials that evaluated interventions intended to mitigate exposure to intraoperative hypotension and prevent complications following the administration of neuraxial anesthesia for major nonobstetric noncardiac surgery.

Source: We searched MEDLINE, Embase, PubMed®, and the Cochrane Controlled Register of Trials (database inception to 2 August 2023) for randomized controlled trials (RCTs) that evaluated interventions intended to reduce hypotension during neuraxial anesthesia in major noncardiac nonobstetric surgery, without any restrictions on the comparator type. The outcomes of interest were any measure of intraoperative hypotension (e.g., incidence, duration) and postoperative complications.

Principal findings: Among 33 included RCTs (n = 3,880) evaluating six classes of interventions, interventions that reduced the risk of hypotension included colloid preload (vs crystalloid, risk ratio [RR], 0.48; 95% confidence interval [CI], 0.30 to 0.80; P = 0.004; I² = 12%; very-low-certainty evidence) and prophylactic ondansetron (vs placebo; RR, 0.64; 95% CI, 0.53 to 0.78; P < 0.001; I² = 39%; moderate-certainty evidence). Prophylactic ephedrine was also associated with reduced time spent in hypotension. Nevertheless, crystalloid preloading did not reduce risks of hypotensive events compared with no preload (RR, 1.36; 95% CI, 0.96 to 1.92; P = 0.09; I² = 0%; very-low-certainty evidence). There were no compelling data showing that these interventions reduced the risks of complications.

Conclusions: Several interventions hold promise for mitigating exposure to hypotension following neuraxial anesthesia, albeit supported by very-low to moderate-certainty evidence. It remains unclear whether these interventions reduce the risks of postoperative complications.

Study registration: PROSPERO ( CRD42022336197 ); first submitted 29 May 2022.

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非产科手术中轴向麻醉后低血压的预防：一项系统综述。

目的：低血压在轴向麻醉中经常发生，并与围手术期并发症的风险增加有关。我们试图对随机对照试验进行系统回顾和荟萃分析，这些试验评估了旨在减轻术中低血压暴露和预防重大非产科非心脏手术中给予神经轴麻醉后并发症的干预措施。来源：我们检索了MEDLINE、Embase、PubMed®和Cochrane对照试验登记册（数据库建立至2023年8月2日），以评估旨在降低重大非心脏非产科手术中轴向麻醉期间低血压的干预措施的随机对照试验（rct），对比较器类型没有任何限制。关注的结果是术中低血压（例如，发生率、持续时间）和术后并发症的任何测量。主要发现：在33项纳入的随机对照试验（n = 3880）中，评估了6类干预措施，降低低血压风险的干预措施包括胶体预负荷(vs .晶体，风险比[RR]， 0.48；95%置信区间[CI]， 0.30 ~ 0.80；p = 0.004；i2 = 12%；极低确定性证据)和预防性昂丹司琼(相对于安慰剂；RR 0.64;95% CI, 0.53 ~ 0.78；p 2 = 39%；moderate-certainty证据)。预防性麻黄碱也与降低低血压时间有关。然而，与未预压相比，晶体预压并没有降低低血压事件的风险(RR, 1.36；95% CI, 0.96 ~ 1.92；p = 0.09；i2 = 0%；very-low-certainty证据)。没有令人信服的数据表明这些干预措施降低了并发症的风险。结论：一些干预措施有望减轻轴向麻醉后的低血压暴露，尽管有非常低到中等确定性的证据支持。目前尚不清楚这些干预措施是否能降低术后并发症的风险。研究注册：PROSPERO (CRD42022336197)；首次提交于2022年5月29日。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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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.