Department of Anesthesiology, Graduate School of Medicine, Chiba University, Chiba, Japan.
Department of Clinical Laboratory, The University of Tokyo Hospital, Hongo 7-3-1, Bunkyo, Tokyo 113-8655, Japan.
J Cardiol. 2021 Sep;78(3):230-236. doi: 10.1016/j.jjcc.2021.03.010. Epub 2021 Apr 8.
Severe hypotension immediately after induction of general anesthesia (post-induction hypotension) is a common complication and is associated with a poor postoperative outcome. We hypothesized that post-induction hypotension results from cardiac dysfunction which can be assessed by preoperative echocardiography.
We retrospectively enrolled 200 patients who had undergone elective surgery within 6 months after preoperative transthoracic echocardiography. The incidence of post-induction hypotension identified from anesthesia records was defined as a decrease in mean blood pressure to ≤50 mmHg after injection of induction anesthetics prior to surgery. Logistic regression analysis of patient characteristics and echocardiographic variables was used to identify the independent factors for post-induction hypotension.
Post-induction hypotension was found in 63 of the 200 cases (incidence 32%). Independent risk factors for post-induction hypotension were the presence of a regional wall motion abnormality (RWMA) [odds ratio (OR), 6.65.; 95% confidence interval (CI), 1.76 - 25.10], an elevated E/e' (OR, 1.13; 95% CI, 1.00 - 1.28), female gender (OR, 3.61; 95% CI, 1.37 - 9.56), and the use of an angiotensin II receptor blocker (OR, 3.17; 95% CI, 1.12 - 8.96).
Assessment of RWMA and E/e' with preoperative transthoracic echocardiography might be helpful for stratification of patients at a risk of post-induction hypotension in general anesthesia.
全麻诱导后即刻发生严重低血压（诱导后低血压）是一种常见的并发症，与术后不良结局相关。我们假设诱导后低血压是由心脏功能障碍引起的，而术前超声心动图可以评估心脏功能障碍。
我们回顾性纳入了 200 例在术前经胸超声心动图检查后 6 个月内接受择期手术的患者。麻醉记录中确定的诱导后低血压发生率定义为手术前诱导麻醉注射后平均血压下降至≤50mmHg。采用逻辑回归分析患者特征和超声心动图变量，以确定诱导后低血压的独立因素。
在 200 例患者中，有 63 例（发生率为 32%）发生诱导后低血压。诱导后低血压的独立危险因素为存在区域性室壁运动异常（RWMA）[比值比（OR），6.65；95%置信区间（CI），1.76-25.10]、E/e'升高（OR，1.13；95%CI，1.00-1.28）、女性（OR，3.61；95%CI，1.37-9.56）和使用血管紧张素 II 受体阻滞剂（OR，3.17；95%CI，1.12-8.96）。
术前经胸超声心动图评估 RWMA 和 E/e'可能有助于分层全麻诱导后低血压风险患者。
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