Wani Tariq M, Hakim Mohammed, Ramesh Archana, Rehman Shabina, Majid Yasser, Miller Rebecca, Tumin Dmitry, Tobias Joseph D
Department of Anesthesia, Pediatric Division, Sidra Medicine, Doha, Qatar.
Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA.
Pediatr Surg Int. 2018 Dec;34(12):1333-1338. doi: 10.1007/s00383-018-4359-5. Epub 2018 Oct 22.
Preoperative factors have been correlated with pre-incision hypotension (PIH) in children undergoing surgery, suggesting that PIH can be predicted through preoperative screening. We studied blood pressure (BP) changes in the 12 min following the induction of anesthesia to study the incidence of post-induction hypotension and to assess the feasibility of predicting PIH in low-risk children without preoperative hypotension or comorbid features.
We retrospectively evaluated 200 patients ranging in age from 2 to 8 years with American Society of Anesthesiologists' (ASA) physical status I or II, undergoing non-cardiac surgery. Patients were excluded if they had preoperative (baseline) hypotension (systolic blood pressure (SBP) < 5th percentile for age). BP and heart rate (HR) were recorded at 3 min intervals for 12 min after the induction of anesthesia. Pre-incision hypotension (PIH) was initially defined as SBP < 5th percentile for age: (1) at any timepoint within 12 min of induction; (2) for the median SBP obtained during the 12 min study period; or (3) at 2 or more timepoints including the final point at 12 min after the induction of anesthesia (sustained hypotension). In addition, we examined PIH defined as > 20% decrease in SBP from baseline: (4) at any timepoint within 12 min of the induction of anesthesia; (5) for the median SBP obtained during the 12 min study period; or (6) at two or more timepoints including the final point at 12 min after the induction of anesthesia. Agreement among the six definitions was analyzed, in addition to the effects of age, gender, type of anesthetic induction, use of premedication, preoperative BP, preoperative HR, and body mass index on the incidence of PIH according to each definition.
Five patients were excluded due to baseline hypotension and six were excluded for missing data. In the remaining cohort, estimated PIH prevalence ranged from 4% [definition (Stewart et al., in Paediatr Anaesth 26:844-851, 2016), sustained PIH according to SBP percentile-for-age] to 57% [definition (Task Force on Blood Pressure Control in Children, in Pediatrics 79:1-25, 1987), at least one timepoint where SBP was > 20% lower than baseline]. Pairwise agreement among the six definitions ranged from 49 to 91% agreement. No sequelae of PIH were noted during subsequent anesthetic or postoperative care. On multivariable analysis, no covariates were consistently associated with PIH risk across all six definitions of PIH.
The present study describes the incidence and prediction of PIH in a cohort of relatively healthy children. In this setting, accurate prediction of PIH appears to be hampered by lack of agreement between definitions of PIH. Overall, there was a low PIH incidence when the threshold of SBP < 5th percentile for age was used.
II.
术前因素与接受手术的儿童术前低血压（PIH）相关，这表明PIH可通过术前筛查进行预测。我们研究了麻醉诱导后12分钟内的血压（BP）变化，以研究诱导后低血压的发生率，并评估在无术前低血压或合并症的低风险儿童中预测PIH的可行性。
我们回顾性评估了200例年龄在2至8岁、美国麻醉医师协会（ASA）身体状况为I或II级、接受非心脏手术的患者。如果患者有术前（基线）低血压（收缩压（SBP）低于年龄对应的第5百分位数），则将其排除。麻醉诱导后每隔3分钟记录一次BP和心率（HR），共记录12分钟。术前低血压（PIH）最初定义为：（1）诱导后12分钟内的任何时间点；（2）12分钟研究期间获得的SBP中位数；或（3）包括麻醉诱导后12分钟的最后一个时间点在内的2个或更多时间点（持续性低血压）。此外，我们还研究了定义为SBP较基线下降>20%的PIH：（4）麻醉诱导后12分钟内的任何时间点；（5）12分钟研究期间获得的SBP中位数；或（6）包括麻醉诱导后12分钟的最后一个时间点在内的2个或更多时间点。分析了六种定义之间的一致性，以及年龄、性别、麻醉诱导类型、术前用药、术前BP、术前HR和体重指数对根据每种定义的PIH发生率的影响。
5例患者因基线低血压被排除，6例因数据缺失被排除。在其余队列中，估计的PIH患病率从4%[定义（Stewart等人，《儿科麻醉学》26:844 - 851，2016年），根据年龄对应的SBP百分位数的持续性PIH]到57%[定义（儿童血压控制特别工作组，《儿科学》79:1 - 25，1987年），至少有一个时间点SBP比基线低>20%]。六种定义之间的两两一致性范围为49%至91%。在随后的麻醉或术后护理期间未发现PIH的后遗症。在多变量分析中，没有协变量在PIH的所有六种定义中都与PIH风险持续相关。
本研究描述了一组相对健康儿童中PIH的发生率和预测情况。在这种情况下，PIH定义之间缺乏一致性似乎阻碍了对PIH的准确预测。总体而言，当使用年龄对应的SBP<第5百分位数的阈值时，PIH发生率较低。
II级。
