Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Br J Anaesth. 2022 Oct;129(4):478-486. doi: 10.1016/j.bja.2022.06.027. Epub 2022 Aug 23.
Hypotension during induction of anaesthesia is associated with organ injury. Continuous arterial pressure monitoring might help reduce hypotension. We tested the hypothesis that continuous intra-arterial compared with intermittent oscillometric arterial pressure monitoring reduces hypotension during induction of anaesthesia in noncardiac surgery patients.
In this single-centre randomised trial, 242 noncardiac surgery patients in whom intra-arterial arterial pressure monitoring was planned were randomised to unblinded continuous intra-arterial or to intermittent oscillometric arterial pressure monitoring (with blinded intra-arterial arterial pressure monitoring) during induction of anaesthesia. The primary endpoint was the area under a mean arterial pressure (MAP) of 65 mm Hg within the first 15 min of induction of anaesthesia. Secondary endpoints included areas under MAP values of 60, 50, and 40 mm Hg and durations of MAP values <65, <60, <50, and <40 mm Hg.
There were 224 subjects available for analysis. The median (25th-75th percentile) area under a MAP of 65 mm Hg was 15 (2-36) mm Hg • min in subjects assigned to continuous intra-arterial monitoring and 46 (7-111) mm Hg • min in subjects assigned to intermittent oscillometric monitoring (P<0.001). Subjects assigned to continuous intra-arterial monitoring had smaller areas under MAP values of 60, 50, and 40 mm Hg and shorter durations of MAP values <65, <60, <50, and <40 mm Hg than subjects assigned to intermittent oscillometric monitoring.
Continuous intra-arterial arterial pressure monitoring reduces hypotension during induction of anaesthesia compared with intermittent oscillometric arterial pressure monitoring in noncardiac surgery patients. In patients for whom an arterial catheter is planned, clinicians might therefore consider inserting the arterial catheter before rather than after induction of anaesthesia.
NCT04894019.
麻醉诱导期间的低血压与器官损伤有关。连续动脉压监测可能有助于减少低血压。我们检验了这样一个假设，即在非心脏手术患者中，与间歇性振荡动脉压监测相比，连续动脉内压监测可减少麻醉诱导期间的低血压。
在这项单中心随机试验中，计划进行动脉内动脉压监测的 242 名非心脏手术患者被随机分为连续动脉内或间歇性振荡动脉压监测组（同时进行动脉内动脉压监测），用于麻醉诱导期间。主要终点是麻醉诱导后 15 分钟内平均动脉压（MAP）65mmHg 的曲线下面积。次要终点包括 MAP 值 60、50 和 40mmHg 的曲线下面积以及 MAP 值<65、<60、<50 和<40mmHg 的持续时间。
共有 224 名患者可用于分析。接受连续动脉内监测的患者 MAP 65mmHg 的曲线下面积中位数（25-75 百分位数）为 15（2-36）mm Hg • min，接受间歇性振荡监测的患者为 46（7-111）mm Hg • min（P<0.001）。与间歇性振荡监测相比，接受连续动脉内监测的患者 MAP 值<65、<60、<50 和<40mmHg 的曲线下面积较小，MAP 值<65、<60、<50 和<40mmHg 的持续时间更短。
与间歇性振荡动脉压监测相比，非心脏手术患者麻醉诱导期间连续动脉内压监测可降低低血压。对于计划使用动脉导管的患者，临床医生可能会考虑在麻醉诱导前而不是后插入动脉导管。
NCT04894019。
