Department of Dental Anesthesiology, Faculty of Dental Medicine and Graduate School of Dental Medicine, Hokkaido University, Nishi 7, Kita 13, Kita-Ku, Sapporo, Japan.
BMC Anesthesiol. 2022 Nov 11;22(1):343. doi: 10.1186/s12871-022-01899-9.
Hypotension during anesthesia induction is a common event, and occurs more frequently in patients with hypertension than in healthy individuals. Intraoperative hypotension in non-cardiac surgery is reportedly associated with various postoperative complications. However, the predictors of hypotension during anesthesia induction in patients with hypertension have not yet been ascertained. Therefore, we aimed to determine the predictors of hypotension during anesthesia induction in patients with hypertension on medication focusing on the half-life of the medication used.
In this retrospective observational study, we enrolled patients with hypertension on medication who underwent general anesthesia for oral and maxillofacial surgery between January 1, 2013, and December 31, 2019. Multivariable logistic regression analysis was conducted to test for associations between clinical factors and hypotension during anesthesia induction in patients with hypertension on medication.
A total of 395 patients were included in this study. The risk factors for hypotension during anesthesia induction in patients with hypertension on medication were pre-induction mean arterial blood pressure (adjusted unit odds ratio, 0.96 [95% confidence interval, 0.94 to 0.98]), female sex (adjusted odds ratio [aOR], 1.63 [1.03 to 2.57]), regular use of angiotensin receptor blockers (ARBs)/angiotensin-converting enzyme inhibitors (ACE-Is) with a long half-life (vs. no regular use of ARBs/ACE-Is aOR, 4.02 [1.77 to 9.12]; vs. regular use of ARBs/ACE-Is with a short-to-middle half-life aOR, 3.17 [1.46 to 6.85]), and regular use of beta blockers (aOR, 2.45 [1.19 to 5.04]). Regular use of calcium channel blockers (aOR, 0.44 [0.25 to 0.77]) was a suppressive factor for hypotension during anesthesia induction in patients with hypertension.
In patients with hypertension on medication, regular use of ARBs/ACE-Is with a long half-life, regular use of beta blockers, low pre-induction mean arterial blood pressure, and female sex were risk factors for hypotension during anesthesia induction. Notably, regular use of ARBs/ACE-Is with a long half-life was a high-risk factor for hypotension during anesthesia induction in patients with hypertension on medication even after a 24-h preoperative withdrawal period.
麻醉诱导期间低血压是一种常见事件，在高血压患者中比在健康个体中更为常见。非心脏手术期间的术中低血压与各种术后并发症有关。然而，高血压患者麻醉诱导期间低血压的预测因素尚未确定。因此，我们旨在确定接受药物治疗的高血压患者麻醉诱导期间低血压的预测因素，重点关注所用药物的半衰期。
在这项回顾性观察性研究中，我们招募了 2013 年 1 月 1 日至 2019 年 12 月 31 日期间因口腔颌面外科手术接受全身麻醉的服用降压药的高血压患者。多变量逻辑回归分析用于测试高血压患者麻醉诱导期间低血压与临床因素之间的关联。
本研究共纳入 395 例患者。服用降压药的高血压患者麻醉诱导期间低血压的危险因素包括：诱导前平均动脉压（调整单位优势比，0.96 [95%置信区间，0.94 至 0.98]）、女性（调整比值比 [aOR]，1.63 [1.03 至 2.57]）、规律使用半衰期较长的血管紧张素受体阻滞剂（ARB）/血管紧张素转换酶抑制剂（ACE-I）（与不规律使用 ARB/ACE-I 相比，aOR，4.02 [1.77 至 9.12]；与规律使用半衰期较短的 ARB/ACE-I 相比，aOR，3.17 [1.46 至 6.85]）和规律使用β受体阻滞剂（aOR，2.45 [1.19 至 5.04]）。钙通道阻滞剂的规律使用（aOR，0.44 [0.25 至 0.77]）是抑制高血压患者麻醉诱导期间低血压的因素。
在服用降压药的高血压患者中，半衰期长的 ARB/ACE-I 规律使用、β受体阻滞剂规律使用、诱导前平均动脉压低和女性是麻醉诱导期间低血压的危险因素。值得注意的是，即使在术前 24 小时停药期后，半衰期长的 ARB/ACE-I 的规律使用也是高血压患者麻醉诱导期间低血压的高危因素。
