Yildirim Serap Aktas, Dogan Lerzan, Sarikaya Zeynep Tugce, Ulugol Halim, Gucyetmez Bulent, Toraman Fevzi
Department of Anesthesiology and Reanimation, Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul 34752, Turkey.
Acibadem Altunizade Hospital, Istanbul 34662, Turkey.
J Clin Med. 2023 Aug 14;12(16):5280. doi: 10.3390/jcm12165280.
Post-induction hypotension frequently occurs and can lead to adverse outcomes. As target-controlled infusion (TCI) obviates the need to calculate the infusion rate manually and helps safer dosing with prompt titration of the drug using complex pharmacokinetic models, the use of TCI may provide a better hemodynamic profile during anesthesia induction. This study aimed to compare TCI versus manual induction and to determine the hemodynamic risk factors for post-induction hypotension.
A total of 200 ASA grade 1-3 patients, aged 24 to 82 years, were recruited and randomly assigned to the TCI (n = 100) or manual induction groups (n = 100). Hemodynamic parameters were monitored with the pressure-recording analytic method. The propofol dosage was adjusted to keep the Bispectral Index between 40 and 60.
Post-induction hypotension was significantly higher in the manual induction group than in the TCI group (34% vs. 13%; < 0.001, respectively). The propofol induction dose did not differ between the groups (TCI: 155 (135-180) mg; manual: 150 (120-200) mg; = 0.719), but the induction time was significantly longer in the TCI group (47 (35-60) s vs. 150 (105-220) s; < 0.001, respectively). In the multivariable Cox regression model, the presence of hypertension, stroke volume index (SVI), cardiac power output (CPO), and anesthesia induction method were found to predict post-induction hypotension ( = 0.032, = 0.013, = 0.024, and = 0.015, respectively).
TCI induction with propofol provided better hemodynamic stability than manual induction, and the presence of hypertension, a decrease in the pre-induction SVI, and the CPO could predict post-induction hypotension.
诱导后低血压经常发生，并可导致不良后果。由于靶控输注（TCI）无需手动计算输注速率，并有助于使用复杂的药代动力学模型进行更安全的给药及迅速滴定药物，TCI的使用可能在麻醉诱导期间提供更好的血流动力学概况。本研究旨在比较TCI与手动诱导，并确定诱导后低血压的血流动力学危险因素。
共招募200例年龄在24至82岁之间的美国麻醉医师协会（ASA）1-3级患者，并随机分配至TCI组（n = 100）或手动诱导组（n = 100）。采用压力记录分析法监测血流动力学参数。调整丙泊酚剂量以使脑电双频指数保持在40至60之间。
手动诱导组诱导后低血压的发生率显著高于TCI组（分别为34%对13%；P<0.001）。两组间丙泊酚诱导剂量无差异（TCI组：155（135-180）mg；手动诱导组：150（120-200）mg；P = 0.719），但TCI组的诱导时间显著更长（分别为47（35-60）秒对150（105-220）秒；P<0.001）。在多变量Cox回归模型中，发现高血压的存在、每搏量指数（SVI）、心输出功率（CPO）和麻醉诱导方法可预测诱导后低血压（P分别为0.032、0.013、0.024和0.015）。
丙泊酚TCI诱导比手动诱导提供了更好的血流动力学稳定性，高血压的存在、诱导前SVI降低和CPO可预测诱导后低血压。
