Different Types of Intraoperative Hypotension and their Association with Post-Anesthesia Care Unit Recovery.
Complication
Hypotension
Intraoperative Hypotension
PACU outcomes
PACU recovery
Journal
Global heart
ISSN: 2211-8179
Titre abrégé: Glob Heart
Pays: England
ID NLM: 101584391
Informations de publication
Date de publication:
2023
2023
Historique:
received:
13
04
2023
accepted:
19
07
2023
medline:
15
8
2023
pubmed:
14
8
2023
entrez:
14
8
2023
Statut:
epublish
Résumé
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.
Sections du résumé
Background
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.
Methods
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.
Results
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.
Conclusions
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.
Registration
Clinicaltrials.gov identifier: NCT05671783.
Identifiants
pubmed: 37577293
doi: 10.5334/gh.1257
pmc: PMC10417939
doi:
Banques de données
ClinicalTrials.gov
['NCT05671783']
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
44Informations de copyright
Copyright: © 2023 The Author(s).
Déclaration de conflit d'intérêts
The authors have no competing interests to declare.
Références
J Clin Anesth. 2017 Feb;36:151-152
pubmed: 28183555
J Clin Anesth. 2021 Sep;72:110310
pubmed: 33932723
Qual Saf Health Care. 2005 Jun;14(3):e11
pubmed: 15933284
J Anesth. 2018 Oct;32(5):673-680
pubmed: 30027443
Anesth Analg. 1993 Feb;76(2):337-41
pubmed: 8424512
Anesth Analg. 2005 Sep;101(3):622-628
pubmed: 16115962
J Bone Joint Surg Am. 2012 Jul 18;94(14):1284-90
pubmed: 22810398
Anaesthesia. 2002 Nov;57(11):1060-6
pubmed: 12392453
Anesthesiology. 2007 Aug;107(2):213-20
pubmed: 17667564
N Engl J Med. 2009 Oct 1;361(14):1368-75
pubmed: 19797283
Neurol Sci. 2021 May;42(5):1751-1758
pubmed: 33687612
Anesth Analg. 2021 Jun 1;132(6):1654-1665
pubmed: 33177322
Anesthesiology. 2013 Sep;119(3):507-15
pubmed: 23835589
Can J Anaesth. 1992 May;39(5 Pt 1):440-8
pubmed: 1596967
Neurol Clin Pract. 2022 Feb;12(1):76-84
pubmed: 36157624
Can J Anaesth. 2015 Feb;62(2):158-68
pubmed: 25391735
Lijec Vjesn. 2010;132 Suppl 1:13-8
pubmed: 20715712
Qual Saf Health Care. 2005 Jun;14(3):e1
pubmed: 15933282
Eur Rev Med Pharmacol Sci. 2021 Nov;25(22):7044-7050
pubmed: 34859868
J Intensive Care Med. 2009 Sep-Oct;24(5):293-316
pubmed: 19703817
Intensive Care Med. 2012 Jun;38(6):950-8
pubmed: 22527060
Br J Anaesth. 2018 Oct;121(4):706-721
pubmed: 30236233
Anaesthesia. 2018 Oct;73(10):1223-1228
pubmed: 30144029
Clin Interv Aging. 2021 Oct 01;16:1757-1767
pubmed: 34621121
Crit Care. 2018 Jul 6;22(1):174
pubmed: 29980217
Anaesthesia. 1988 Mar;43 Suppl:25-31
pubmed: 3259092
Circulation. 2008 Sep 2;118(10):1047-56
pubmed: 18765387
Curr Opin Anaesthesiol. 2016 Jun;29(3):391-6
pubmed: 26978592
Br J Anaesth. 2017 Jul 01;119(1):57-64
pubmed: 28974066
Anesth Analg. 1998 Sep;87(3):628-33
pubmed: 9728843
Health Sci Rep. 2022 May 23;5(3):e649
pubmed: 35620534