Rosenberger Peter, Shernan Stanton K, Shekar Prem S, Tuli Jayshree K, Weissmüller Thomas, Aranki Sary F, Eltzschig Holger K
Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Anesth Analg. 2006 May;102(5):1311-5. doi: 10.1213/01.ane.0000208970.14762.7f.
Patients undergoing pulmonary embolectomy often experience hemodynamic deterioration during induction of general anesthesia (GA). Therefore, we studied the incidence and possible risk factors for hemodynamic deterioration during GA induction. Fifty-two consecutive patients undergoing emergent pulmonary embolectomy at our institution were included. Hemodynamic collapse after GA induction was defined as hypotension refractory to vasopressor, inotrope, or fluid administration, requiring cardiopulmonary resuscitation followed by urgent institution of cardiopulmonary bypass (CPB). Demographic variables, comorbidities, specific location of thromboemboli, preoperative inotropic support, and anesthetic drugs used for GA induction were evaluated as possible risk factors. After GA induction, hemodynamic collapse occurred in 19% of patients (n = 10). However, the occurrence of hemodynamic instability was not predicted by any of the evaluated risk factors. In addition, the incidence of in-hospital mortality did not differ between hemodynamically stable or unstable patients (10%; 4 of 42 versus 10%; 1 of 10 patients, respectively). In conclusion, hemodynamic deterioration after GA induction develops frequently during emergent pulmonary embolectomy. On the basis of our experience from this study and the unpredictable nature of hemodynamic deterioration, we suggest that patients undergoing pulmonary embolectomy should be prepared and draped before GA induction, and a cardiac surgical team should immediately be available for emergent institution of cardiopulmonary bypass.
接受肺血栓切除术的患者在全身麻醉诱导期间常出现血流动力学恶化。因此，我们研究了全身麻醉诱导期间血流动力学恶化的发生率及可能的危险因素。纳入了在我们机构连续接受急诊肺血栓切除术的52例患者。全身麻醉诱导后血流动力学崩溃定义为对血管升压药、正性肌力药或液体输注无反应的低血压，需要进行心肺复苏，随后紧急建立体外循环（CPB）。评估人口统计学变量、合并症、血栓栓塞的具体位置、术前正性肌力支持以及全身麻醉诱导所用的麻醉药物作为可能的危险因素。全身麻醉诱导后，19%的患者（n = 10）发生了血流动力学崩溃。然而，所评估的任何危险因素均未预测出血流动力学不稳定的发生。此外，血流动力学稳定或不稳定的患者住院死亡率无差异（分别为10%；42例中的4例与10%；10例中的1例）。总之，在急诊肺血栓切除术中，全身麻醉诱导后血流动力学恶化经常发生。基于本研究的经验以及血流动力学恶化的不可预测性，我们建议接受肺血栓切除术的患者在全身麻醉诱导前应做好准备并铺巾，并且心脏外科团队应随时可用于紧急建立体外循环。
