Department of Anesthesiology and Reanimation, Acibadem University, Istanbul, Turkey.
Glob Heart. 2023 Aug 11;18(1):44. doi: 10.5334/gh.1257. eCollection 2023.
The underlying causative mechanism leading to intraoperative hypotension (IOH) may vary depending on the stage of anesthesia and surgery, resulting in different types of IOH. Consequently, the incidence, severity, and postoperative complications associated with IOH types may differ. This study explores the association between IOH types and post-anesthesia care unit (PACU) recovery, with a focus on duration and complications.
From May 2022 to December 2022, we included 4776 consecutive surgical patients aged ≥18 who underwent elective surgery with planned overnight stays at Acibadem Altunizade Hospital and received general anesthesia. Post-induction hypotension (pIOH) was defined as a decrease in blood pressure during the first 20 minutes after anesthesia induction, while maintenance intraoperative hypotension (mIOH) referred to a decrease in blood pressure occurring after the 20th minute following induction, with or without preceding pIOH.
Among the included patients, 22.13% experienced IOH, with a higher prevalence observed among females. Patients with mIOH exhibited higher rates of bleeding, transfusions, hypothermia, longer stays in the PACU, and increased oxygen requirements. The duration of anesthesia did not increase the likelihood of IOH. Multivariate logistic regression analysis revealed that ephedrine usage, hypothermia, the need for additional analgesics, nausea, and vomiting were factors associated with longer PACU duration. Older patients (≥65), patients with ASA≥2 status, those undergoing major surgery, experiencing unexpected bleeding, and exhibiting hypothermia at the end of anesthesia had a higher likelihood of requiring vasopressor support.
Patients experiencing hypotension, particularly during the maintenance of anesthesia, are more prone to complications in the PACU and require closer monitoring and treatment. Although less common, mIOH has a more significant impact on outcomes compared to other factors affecting PACU recovery. The impact of mIOH on PACU duration should not be overlooked in favor of other factors.
Clinicaltrials.gov identifier: NCT05671783.
导致术中低血压（IOH）的潜在因果机制可能因麻醉和手术阶段而异，导致不同类型的 IOH。因此，不同类型的 IOH 的发生率、严重程度和术后并发症可能不同。本研究探讨了 IOH 类型与麻醉后恢复室（PACU）恢复之间的关系，重点是持续时间和并发症。
2022 年 5 月至 2022 年 12 月，我们纳入了 4776 名连续接受择期手术且计划在 Acibadem Altunizade 医院过夜的年龄≥18 岁的手术患者，这些患者接受全身麻醉。诱导后低血压（pIOH）定义为麻醉诱导后 20 分钟内血压下降，而维持性术中低血压（mIOH）则指诱导后 20 分钟后发生的血压下降，无论是否存在 pIOH。
在纳入的患者中，22.13%发生了 IOH，女性的发生率更高。mIOH 患者的出血、输血、低体温、PACU 停留时间延长和增加氧气需求的发生率更高。麻醉时间的延长并不会增加 IOH 的可能性。多变量逻辑回归分析显示，使用麻黄碱、低体温、需要额外的镇痛剂、恶心和呕吐是与 PACU 持续时间延长相关的因素。年龄较大（≥65 岁）、ASA 状态≥2 级、接受大手术、意外出血以及麻醉结束时出现低体温的患者更有可能需要血管加压药支持。
发生低血压的患者，特别是在麻醉维持期间，更有可能在 PACU 中出现并发症，需要更密切的监测和治疗。尽管不太常见，但 mIOH 对 PACU 恢复结果的影响比其他影响 PACU 恢复的因素更为显著。在考虑其他因素的同时，不应忽视 mIOH 对 PACU 持续时间的影响。
Clinicaltrials.gov 标识符：NCT05671783。
