Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, 03080 Seoul, South Korea.
J Clin Anesth. 2023 Nov;90:111236. doi: 10.1016/j.jclinane.2023.111236. Epub 2023 Aug 26.
To determine whether changes in the pleth variability index (PVi) during preoxygenation with forced ventilation for 1 min could predict anesthesia-induced hypotension.
Prospective, observational study.
A tertiary teaching hospital.
Ninety-six patients who underwent general anesthesia using total intravenous anesthesia were enrolled.
Upon the patient's arrival at the preoperative waiting area, a PVi sensor was affixed to their fourth fingertip. For preoxygenation, forced ventilation of 8 breaths/min in a 1:2 inspiratory-expiratory ratio was conducted using the guidance of an audio file. One minute after preoxygenation, anesthetic administration was initiated. Blood pressure was measured for the next 15 min.
We calculated the difference (dPVi) and percentage of change (%PVi) between the PVi values immediately before and after forced ventilation. Anesthesia-induced hypotension was defined as a mean arterial pressure of <60 mmHg within 15 min after the infusion of anesthetics.
Overall, 87 patients were included in the final analysis. Anesthesia-induced hypotension occurred in 31 (35.6%) of the 87 patients. Receiver operating characteristic curve analyses identified a cut-off value of -2 for dPVi, with an area under the curve of 0.691 (95% confidence interval [CI], 0.564-0.818; P < 0.001) and a cut-off value of -7.6% for %PVi, with an area under the curve of 0.711 (95% CI, 0.589-0.832; P < 0.001). Further, multivariate logistic regression analysis showed that a low %PVi with an odds ratio of 9.856 (95% CI, 3.131-31.032; P < 0.001) was a significant determinant of anesthesia-induced hypotension.
Hypotension frequently occurs during general anesthesia induction and can impact outcomes. Additionally, the percentage change in the PVi before and after preoxygenation using deep breathing can be used to predict anesthesia-induced hypotension.
确定预氧合期间通过强制通气 1 分钟引起的容积脉搏变异指数（PVi）变化是否可以预测麻醉诱导性低血压。
前瞻性观察研究。
一家三级教学医院。
纳入 96 名接受全凭静脉麻醉的全麻患者。
患者到达术前等候区时，将 PVi 传感器贴在第四指尖上。预充氧时，在音频文件的指导下以 1:2 的吸呼比进行 8 次/分钟的强制通气。预充氧 1 分钟后，开始给予麻醉剂。在接下来的 15 分钟内测量血压。
我们计算了强制通气前后 PVi 值之间的差值（dPVi）和百分比变化（%PVi）。麻醉诱导性低血压定义为麻醉剂输注后 15 分钟内平均动脉压<60mmHg。
共有 87 例患者最终纳入分析。87 例患者中有 31 例（35.6%）发生麻醉诱导性低血压。接受者操作特征曲线分析确定 dPVi 的截断值为-2，曲线下面积为 0.691（95%置信区间 [CI]，0.564-0.818；P<0.001），%PVi 的截断值为-7.6%，曲线下面积为 0.711（95%CI，0.589-0.832；P<0.001）。此外，多变量逻辑回归分析显示，低 %PVi 的优势比为 9.856（95%CI，3.131-31.032；P<0.001），是麻醉诱导性低血压的显著决定因素。
全麻诱导时经常发生低血压，会影响结局。此外，深吸气前后 PVi 的百分比变化可用于预测麻醉诱导性低血压。
