Department of Anesthesiology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
Department of Epidemiology, Julius Center for Health Sciences and Primary Care, Utrecht University, Utrecht, the Netherlands.
Acta Anaesthesiol Scand. 2020 Apr;64(4):472-480. doi: 10.1111/aas.13520. Epub 2019 Dec 22.
Intraoperative blood pressure has been suggested as a key factor for safe pediatric anesthesia. However, there is not much insight into factors that discriminate between children with low and normal pre-incision blood pressure. Our aim was to explore whether children who have a low blood pressure during anesthesia are different than those with normal blood pressure. The focus of the present study was on the pre-incision period.
This retrospective study included pediatric patients undergoing anesthesia for non-cardiac surgery at a tertiary pediatric university hospital, between 2012 and 2016. We analyzed the association between pre-incision blood pressure and patient- and anesthesia characteristics, comparing low with normal pre-incision blood pressure. This association was further explored with a multivariable linear regression.
In total, 20 962 anesthetic cases were included. Pre-incision blood pressure was associated with age (beta -0.04 SD per year), gender (female -0.11), previous surgery (-0.15), preoperative blood pressure (+0.01 per mm Hg), epilepsy (0.12), bronchial hyperactivity (-0.18), emergency surgery (0.10), loco-regional technique (-0.48), artificial airway device (supraglottic airway device instead of tube 0.07), and sevoflurane concentration (0.03 per sevoflurane %).
Children with low pre-incision blood pressure do not differ on clinically relevant factors from children with normal blood pressure. Although the present explorative study shows that pre-incision blood pressure is partly dependent on patient characteristics and partly dependent on anesthetic technique, other unmeasured variables might play a more important role.
术中血压被认为是小儿麻醉安全的关键因素。然而，对于区分血压低和正常的术前儿童的因素，我们知之甚少。我们的目的是探讨在麻醉期间血压低的儿童与血压正常的儿童是否存在差异。本研究的重点是术前阶段。
本回顾性研究纳入了 2012 年至 2016 年期间在一家三级儿童医院行非心脏手术麻醉的儿科患者。我们分析了术前血压与患者和麻醉特点之间的关系，比较了血压低和正常的患者。使用多变量线性回归进一步探讨了这种关联。
共纳入 20962 例麻醉病例。术前血压与年龄（每年 -0.04 个标准差）、性别（女性 -0.11）、既往手术（-0.15）、术前血压（每毫米汞柱增加 0.01）、癫痫（0.12）、支气管高反应性（-0.18）、急诊手术（0.10）、局部技术（喉罩替代气管插管 -0.48）、人工气道装置（使用会厌上气道装置而非气管插管 0.07）和七氟醚浓度（每增加 0.03%七氟醚）相关。
血压低的患儿与血压正常的患儿在临床相关因素方面无差异。虽然本研究为探索性研究，但表明术前血压部分取决于患者特点，部分取决于麻醉技术，但其他未测量的变量可能发挥更重要的作用。
