Amsterdam UMC, University of Amsterdam, Department of Anesthesiology, Meibergdreef 9, 1105AZ, Amsterdam, Netherlands.
Amsterdam UMC, University of Amsterdam, Department of Anesthesiology, Meibergdreef 9, 1105AZ, Amsterdam, Netherlands; Amsterdam UMC, University of Amsterdam, Department of Intensive Care, Meibergdreef 9, 1105AZ, Amsterdam, Netherlands.
J Clin Anesth. 2024 Dec;99:111671. doi: 10.1016/j.jclinane.2024.111671. Epub 2024 Oct 28.
To identify the influence of modifiable factors in anesthesia induction strategy on post-induction hypotension (PIH), specifically the type, dosage and speed of administration of induction agents. A secondary aim was to identify patient related non-modifiable factors associated with PIH.
Single-center, prospective observational cohort study.
Operating room.
Adult, ASA I-IV patients undergoing elective, non-cardiac surgery under general anesthesia (GA).
None.
Continuous non-invasive blood pressure using finger-cuff technology. PIH was defined as mean arterial pressure (MAP) <65 mmHg ≥1 min, and, separately, as a > 30 % decrease from baseline MAP ≥1 min.
Study measurements were performed in 760 patients, of which 720 were suitable for analysis. A total of 238 patients (33.1 %) experienced PIH according to the 65 mmHg threshold, and 287 (39.9 %) using the 30 % decrease in MAP threshold. Remifentanil administration was associated with increased risk of PIH according to either definition (MAP <65 mmHg: OR 1.88, 95 %CI 1.31-2.69, p < 0.001, 30 % MAP decrease: OR 1.66, 95 %CI 1.15-2.40, p = 0.007). Pre-emptive vasopressor use (before or during first minute of GA) was associated with reduced risk of PIH (MAP <65 mmHg: OR 0.65, 95 %CI 0.45-0.95, p = 0.027, MAP 30 % decrease: OR 0.58, 95 %CI 0.40-0.84, p = 0.004). Speed of propofol bolus administration, propofol bolus dose, and esketamine use were not associated with PIH in multivariable analysis. Propofol bolus dose decreased with increasing age and American Society of Anesthesiologists physical status classification.
PIH was common in this patient cohort, regardless of the definition used. Two of the five examined modifiable factors were associated with PIH: remifentanil infusion was associated with an increased risk, and pre-emptive vasopressor use was associated with a decreased risk of PIH. No association between propofol dose and PIH was found, most likely due dose adjustment based on clinical assessment rather than a true absence of effect.
This study was registered in the Dutch Medical Research in Humans (OMON) register on 18 June 2019 (ID: NL7810). The study was approved by the Medical Ethics Committee of the Amsterdam UMC, location AMC, the Netherlands in December 2018 (NL 6748.018.18; 2018).
确定麻醉诱导策略中可改变因素对诱导后低血压（PIH）的影响，特别是诱导剂的类型、剂量和给药速度。次要目的是确定与 PIH 相关的患者不可改变的因素。
单中心、前瞻性观察性队列研究。
手术室。
ASA I-IV 级、择期行非心脏手术、全身麻醉（GA）的成年患者。
无。
使用手指袖带技术连续测量无创血压。PIH 定义为平均动脉压（MAP）<65mmHg ≥1 分钟，分别为 MAP 较基线下降>30%≥1 分钟。
在 760 名患者中进行了研究测量，其中 720 名适合进行分析。共有 238 名患者（33.1%）根据 65mmHg 阈值发生 PIH，287 名患者（39.9%）根据 MAP 下降 30%的阈值发生 PIH。根据任何一种定义，瑞芬太尼的使用与 PIH 的发生风险增加相关（MAP<65mmHg：OR 1.88，95%CI 1.31-2.69，p<0.001，MAP 下降 30%：OR 1.66，95%CI 1.15-2.40，p=0.007）。预先使用血管加压药（在 GA 的前 1 分钟或期间使用）与 PIH 风险降低相关（MAP<65mmHg：OR 0.65，95%CI 0.45-0.95，p=0.027，MAP 下降 30%：OR 0.58，95%CI 0.40-0.84，p=0.004）。在多变量分析中，丙泊酚推注速度、丙泊酚推注剂量和依托咪酯的使用与 PIH 无关。丙泊酚推注剂量随年龄和美国麻醉医师协会身体状况分类的增加而降低。
在该患者队列中，无论使用哪种定义，PIH 都很常见。在五个检查的可改变因素中有两个与 PIH 相关：瑞芬太尼输注与 PIH 风险增加相关，而预先使用血管加压药与 PIH 风险降低相关。未发现丙泊酚剂量与 PIH 之间存在关联，这很可能是由于基于临床评估而调整了剂量，而不是真正不存在影响。
这项研究于 2019 年 6 月 18 日在荷兰人类医学研究（OMON）登记处注册（ID：NL7810）。该研究于 2018 年 12 月由阿姆斯特丹 UMC 的医学伦理委员会批准，地点为 AMC，荷兰（NL 6748.018.18；2018 年）。
