诱导后低血压发生率的差异取决于一天中的时间：事后倾向评分匹配分析

IF 5.1 2区医学 Q1 ANESTHESIOLOGY

Journal of Clinical Anesthesia Pub Date : 2025-09-03 DOI:10.1016/j.jclinane.2025.111984

Johan T.M. Tol MD , Arjen J.G. Meewisse MD , Sijm H. Noteboom MSc , Ward H. van der Ven MD , Vincent C. Kurucz MD , Lotte E. Terwindt MD , Eline Kho PhD , Björn van der Ster PhD , Alexander P.J. Vlaar MD PhD , Dirk J. Stenvers MD PhD , Jeroen Hermanides MD PhD , Mark L. van Zuylen MD PhD , Denise P. Veelo MD PhD , Jimmy Schenk PhD

{"title":"诱导后低血压发生率的差异取决于一天中的时间：事后倾向评分匹配分析","authors":"Johan T.M. Tol MD , Arjen J.G. Meewisse MD , Sijm H. Noteboom MSc , Ward H. van der Ven MD , Vincent C. Kurucz MD , Lotte E. Terwindt MD , Eline Kho PhD , Björn van der Ster PhD , Alexander P.J. Vlaar MD PhD , Dirk J. Stenvers MD PhD , Jeroen Hermanides MD PhD , Mark L. van Zuylen MD PhD , Denise P. Veelo MD PhD , Jimmy Schenk PhD","doi":"10.1016/j.jclinane.2025.111984","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>Many physiological processes show a diurnal rhythm, including sympathetic and parasympathetic tone, adrenal hormone secretion and blood pressure. Since these physiological rhythms may affect the sensitivity to anaesthesia, we hypothesised that the time of day when anaesthesia induction occurs may affect the incidence of post-induction hypotension.</div></div><div><h3>Methods</h3><div>This was a post-hoc propensity score matched analysis of prospectively collected blood pressure data of 760 elective non-cardiac surgery patients receiving general anaesthesia. The primary endpoint was the incidence of post-induction hypotension, defined as mean arterial pressure < 65 mmHg for at least one minute. Secondary endpoints were a > 30 % decrease in mean arterial pressure, and baroreflex sensitivity.</div></div><div><h3>Results</h3><div>In the analysis of 237 propensity score matched pairs, post-induction hypotension was more frequent if anaesthesia induction occurred in the morning (08:00 AM - 12:00 PM) (odds ratio (OR) 1.48, 95 % confidence interval (CI): 1.00–2.20, <em>p</em> = 0.049). Secondary analyses of the matched cohort showed that a > 30 % decrease in mean arterial pressure was likewise more frequent in the morning than the afternoon (12:00 PM – 17:00 PM) (OR 1.45, 95 % CI: 1.00–2.11, <em>p</em> = 0.0499), but no differences in instantaneous baroreflex sensitivity were observed.</div></div><div><h3>Conclusions</h3><div>Post-induction hypotension was more frequent in the morning compared to the afternoon. While this finding is in line with the presumed physiological mechanisms, it may be affected by unmeasured confounding. These findings should be replicated in larger, preferably randomised, studies to confirm whether a causal relationship between the time of day of anaesthesia induction and post-induction hypotension exists.</div><div><strong>Clinical registration number</strong></div><div>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, Netherlands in December 2018 (NL 6748.018.18; 2018).</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"107 ","pages":"Article 111984"},"PeriodicalIF":5.1000,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Differences in incidence of post-induction hypotension depending on the time of day: a post-hoc propensity score matched analysis\",\"authors\":\"Johan T.M. Tol MD , Arjen J.G. Meewisse MD , Sijm H. Noteboom MSc , Ward H. van der Ven MD , Vincent C. Kurucz MD , Lotte E. Terwindt MD , Eline Kho PhD , Björn van der Ster PhD , Alexander P.J. Vlaar MD PhD , Dirk J. Stenvers MD PhD , Jeroen Hermanides MD PhD , Mark L. van Zuylen MD PhD , Denise P. Veelo MD PhD , Jimmy Schenk PhD\",\"doi\":\"10.1016/j.jclinane.2025.111984\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><div>Many physiological processes show a diurnal rhythm, including sympathetic and parasympathetic tone, adrenal hormone secretion and blood pressure. Since these physiological rhythms may affect the sensitivity to anaesthesia, we hypothesised that the time of day when anaesthesia induction occurs may affect the incidence of post-induction hypotension.</div></div><div><h3>Methods</h3><div>This was a post-hoc propensity score matched analysis of prospectively collected blood pressure data of 760 elective non-cardiac surgery patients receiving general anaesthesia. The primary endpoint was the incidence of post-induction hypotension, defined as mean arterial pressure < 65 mmHg for at least one minute. Secondary endpoints were a > 30 % decrease in mean arterial pressure, and baroreflex sensitivity.</div></div><div><h3>Results</h3><div>In the analysis of 237 propensity score matched pairs, post-induction hypotension was more frequent if anaesthesia induction occurred in the morning (08:00 AM - 12:00 PM) (odds ratio (OR) 1.48, 95 % confidence interval (CI): 1.00–2.20, <em>p</em> = 0.049). Secondary analyses of the matched cohort showed that a > 30 % decrease in mean arterial pressure was likewise more frequent in the morning than the afternoon (12:00 PM – 17:00 PM) (OR 1.45, 95 % CI: 1.00–2.11, <em>p</em> = 0.0499), but no differences in instantaneous baroreflex sensitivity were observed.</div></div><div><h3>Conclusions</h3><div>Post-induction hypotension was more frequent in the morning compared to the afternoon. While this finding is in line with the presumed physiological mechanisms, it may be affected by unmeasured confounding. These findings should be replicated in larger, preferably randomised, studies to confirm whether a causal relationship between the time of day of anaesthesia induction and post-induction hypotension exists.</div><div><strong>Clinical registration number</strong></div><div>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, Netherlands in December 2018 (NL 6748.018.18; 2018).</div></div>\",\"PeriodicalId\":15506,\"journal\":{\"name\":\"Journal of Clinical Anesthesia\",\"volume\":\"107 \",\"pages\":\"Article 111984\"},\"PeriodicalIF\":5.1000,\"publicationDate\":\"2025-09-03\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Clinical Anesthesia\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S0952818025002454\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"ANESTHESIOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Clinical Anesthesia","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0952818025002454","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ANESTHESIOLOGY","Score":null,"Total":0}

引用次数: 0

摘要

许多生理过程表现出昼夜节律，包括交感神经和副交感神经张力、肾上腺激素分泌和血压。由于这些生理节律可能会影响对麻醉的敏感性，我们假设麻醉诱导发生的时间可能会影响诱导后低血压的发生率。方法对760例接受全身麻醉的选择性非心脏手术患者的前瞻性血压数据进行事后倾向评分匹配分析。主要终点是诱导后低血压的发生率，定义为平均动脉压65mmhg持续至少一分钟。次要终点是平均动脉压和气压反射敏感性降低30%。结果237对倾向评分匹配分析中，上午（08:00 AM - 12:00 PM）麻醉诱导后低血压发生率较高（优势比1.48,95%可信区间1.00-2.20,p = 0.049）。对匹配队列的二次分析显示，平均动脉压下降30%同样在上午比下午（12:00 PM - 17:00 PM）更常见（OR 1.45, 95% CI: 1.00-2.11, p = 0.0499），但在瞬时气压反射敏感性方面没有观察到差异。结论诱导后低血压发生在上午较下午多。虽然这一发现与假定的生理机制一致，但它可能受到未测量的混杂因素的影响。这些发现应该在更大的、最好是随机的研究中得到重复，以证实麻醉诱导的时间和诱导后低血压之间是否存在因果关系。本研究于2019年6月18日在荷兰人类医学研究（OMON）登记处注册（ID: NL7810）。该研究于2018年12月获得荷兰阿姆斯特丹UMC医学伦理委员会批准（NL 6748.018.18; 2018）。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

查看原文本刊更多论文

Differences in incidence of post-induction hypotension depending on the time of day: a post-hoc propensity score matched analysis

Background

Many physiological processes show a diurnal rhythm, including sympathetic and parasympathetic tone, adrenal hormone secretion and blood pressure. Since these physiological rhythms may affect the sensitivity to anaesthesia, we hypothesised that the time of day when anaesthesia induction occurs may affect the incidence of post-induction hypotension.

Methods

This was a post-hoc propensity score matched analysis of prospectively collected blood pressure data of 760 elective non-cardiac surgery patients receiving general anaesthesia. The primary endpoint was the incidence of post-induction hypotension, defined as mean arterial pressure < 65 mmHg for at least one minute. Secondary endpoints were a > 30 % decrease in mean arterial pressure, and baroreflex sensitivity.

Results

In the analysis of 237 propensity score matched pairs, post-induction hypotension was more frequent if anaesthesia induction occurred in the morning (08:00 AM - 12:00 PM) (odds ratio (OR) 1.48, 95 % confidence interval (CI): 1.00–2.20, p = 0.049). Secondary analyses of the matched cohort showed that a > 30 % decrease in mean arterial pressure was likewise more frequent in the morning than the afternoon (12:00 PM – 17:00 PM) (OR 1.45, 95 % CI: 1.00–2.11, p = 0.0499), but no differences in instantaneous baroreflex sensitivity were observed.

Conclusions

Post-induction hypotension was more frequent in the morning compared to the afternoon. While this finding is in line with the presumed physiological mechanisms, it may be affected by unmeasured confounding. These findings should be replicated in larger, preferably randomised, studies to confirm whether a causal relationship between the time of day of anaesthesia induction and post-induction hypotension exists.

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, Netherlands in December 2018 (NL 6748.018.18; 2018).

求助全文

通过发布文献求助，成功后即可免费获取论文全文。去求助

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.