The influence of anesthetic drug strategy on the incidence of post-induction hypotension in elective, non-cardiac surgery - A prospective observational cohort study.

Autor: Terwindt LE; Amsterdam UMC, University of Amsterdam, Department of Anesthesiology, Meibergdreef 9, 1105AZ, Amsterdam, Netherlands., Tol JTM; Amsterdam UMC, University of Amsterdam, Department of Anesthesiology, Meibergdreef 9, 1105AZ, Amsterdam, Netherlands., van der Ven WH; Amsterdam UMC, University of Amsterdam, Department of Anesthesiology, Meibergdreef 9, 1105AZ, Amsterdam, Netherlands., Kurucz VC; Amsterdam UMC, University of Amsterdam, Department of Anesthesiology, Meibergdreef 9, 1105AZ, Amsterdam, Netherlands., Noteboom SH; 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., Breel JS; Amsterdam UMC, University of Amsterdam, Department of Anesthesiology, Meibergdreef 9, 1105AZ, Amsterdam, Netherlands., van der Ster BJP; Amsterdam UMC, University of Amsterdam, Department of Anesthesiology, Meibergdreef 9, 1105AZ, Amsterdam, Netherlands., Kho E; 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., Immink RV; Amsterdam UMC, University of Amsterdam, Department of Anesthesiology, Meibergdreef 9, 1105AZ, Amsterdam, Netherlands., Schenk J; Amsterdam UMC, University of Amsterdam, Department of Anesthesiology, Meibergdreef 9, 1105AZ, Amsterdam, Netherlands; Amsterdam UMC, University of Amsterdam, Department of Epidemiology and Data Science, Meibergdreef 9, 1105AZ, Amsterdam, the Netherlands., Vlaar APJ; Amsterdam UMC, University of Amsterdam, Department of Intensive Care, Meibergdreef 9, 1105AZ, Amsterdam, Netherlands; Amsterdam UMC, University of Amsterdam, Laboratory of Experimental Intensive Care and Anesthesiology, Meibergdreef 9, 1105AZ, Amsterdam, Netherlands., Hollmann MW; Amsterdam UMC, University of Amsterdam, Department of Anesthesiology, Meibergdreef 9, 1105AZ, Amsterdam, Netherlands; Amsterdam UMC, University of Amsterdam, Laboratory of Experimental Intensive Care and Anesthesiology, Meibergdreef 9, 1105AZ, Amsterdam, Netherlands. Electronic address: m.w.hollmann@amsterdamumc.nl., Veelo DP; Amsterdam UMC, University of Amsterdam, Department of Anesthesiology, Meibergdreef 9, 1105AZ, Amsterdam, Netherlands.
Jazyk: angličtina
Zdroj: Journal of clinical anesthesia [J Clin Anesth] 2024 Dec; Vol. 99, pp. 111671. Date of Electronic Publication: 2024 Oct 28.
DOI: 10.1016/j.jclinane.2024.111671
Abstrakt: Study Objectives: 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.
Design: Single-center, prospective observational cohort study.
Setting: Operating room.
Patients: Adult, ASA I-IV patients undergoing elective, non-cardiac surgery under general anesthesia (GA).
Interventions: None.
Measurements: 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.
Main Results: 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.
Conclusions: 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.
Clinical Registration Number: 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).
Competing Interests: Declaration of competing interest The Department of Anesthesiology of the Amsterdam UMC, location AMC received financial support for this project from Edwards Lifesciences. DPV reports having received consultancy fees and research grants from Philips NV. APJV reports having received grants and consulting fees from CSL Behring, InflaRx and Edwards Lifesciences paid to the institution. MWH reported serving as Executive Section Editor Pharmacology with Anesthesia & Analgesia, Section Editor Anaesthesiology with the Journal of Clinical Medicine, Editor with Frontiers in Physiology and honorarium for consultancy and advisory board function from Medical Developments, IDD Pharma & PAION. The other authors declare that they have no conflict of interest. None of the investigators of the Amsterdam UMC, location AMC have any form of (in) direct ownership in the software or hardware of Edwards and/or subject of this study. Also no rights or claims to rights exist that might lead to financial gains for any of the authors or the Amsterdam UMC, location AMC as an institution.
(Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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