A retrospective cohort analysis for the risk factors of intraoperative hypotension

Dai, Shenyu; Li, Xinglu; Yang, Yihong; Cao, Yanan; Wang, E.; Dong, Zhitao

doi:10.1111/ijcp.13521

Cited by 15 publications

(11 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The difference was statistically and clinically significant, which can be explained by the correlation between the disease's pathophysiology and the nonuse of antihypertensive medications. This MAPpost-ind reduction in non-treated hypertensive patients also shows the importance of discriminate this group of patients in the preoperative period and manage them pharmacologically appropriately before the surgery to prevent possible intra and postoperative complications, as previously demonstrated by other authors [1,2,5,6,16,22]. This retrospective study has obvious limitations.…”

Section: Comparison Of Preoperative and Preinduction Bpmentioning

confidence: 57%

Relationship among Preoperative, Pre and Postinduction Blood Pressure in Normotensive and Hypertensive Patients

De¹,

De²,

Infante³

et al. 2020

J Clin Anesth Pain Manag

View full text Add to dashboard Cite

Objectives: This study aimed to verify the relationship between blood pressure (BP) obtained during preoperative evaluation at preinduction and compared to BP at 20 min after induction for normotensive and hypertensive patients.Methods: Data from patients who underwent elective surgical procedures from July 2018 to September 2019 were retrospectively extracted and analyzed. The data included patient characteristics (age, sex, weight, height, body mass index (BMI)), physical status (ASA classification), comorbidities, medications in use, and mean arterial BP (MAP) recorded preoperatively (MAPpre-op), before induction of anesthesia (MAPpre-ind), and 20 min after induction (MAPpost-ind).Results: A total of 1026 patients were selected, 341 were included in the final analysis (normotensive patients (GNT n = 203), treated hypertensive patients (GTREAT n = 98), untreated hypertensive patients (GNO TREAT n = 40). There was an increase in the median MAP from preoperation to preinduction in the total sample and the three groups (GNT, GTREAT, and GNO TREAT). There was a statistically significant reduction in MAPpost-ind concerning MAPpre-ind and MAPpre-op in the three groups. The three groups' comparison showed a statistically significant difference between MAPpost-ind and MAPpre-ind and between MAPpost-ind and MAPpre-op. Conclusions:Our study showed that normotensive and hypertensive patients showed a significant BP increase at the preinduction time point. Treated and untreated hypertensive patients had a more considerable increase in preinduction BP and BP reduction at 20 min after anesthesia induction than normotensive patients. These changes were more significant in hypertensive patients without treatment.

show abstract

Section: Comparison Of Preoperative and Preinduction Bpmentioning

confidence: 57%

Relationship among Preoperative, Pre and Postinduction Blood Pressure in Normotensive and Hypertensive Patients

De¹,

De²,

Infante³

et al. 2020

J Clin Anesth Pain Manag

View full text Add to dashboard Cite

show abstract

“…A history of hypertension and dyslipidemia were associated with increased odds that the patients would have an intraoperative hypotensive episode. A recent cohort analysis for the risk factors of intraoperative hypotension in non-beach chair surgery also found that history of hypertension is one of the independent risk factors that increase the risk of intraoperative hypotension [2]. Choi et al [1] conducted a retrospective analysis of 420 patients who underwent shoulder surgery in the beach chair position.…”

Section: Risk Factors For Intraoperative Hypotensionmentioning

confidence: 99%

What Is the Risk of Intraoperative Cerebral Oxygen Desaturation in Patients Undergoing Shoulder Surgery in the Beach Chair Position?

Thanaboriboon

Vanichvithya

Jinaworn

2021

Clin Orthop Relat Res

View full text Add to dashboard Cite

Background Previous studies have shown that intraoperative cerebral desaturation in patients undergoing shoulder surgery in the beach chair position varies widely, from 0% to 80%. To our knowledge, the risk of intraoperative cerebral desaturation is not known after all identified intraoperative modifiable physiologic parameters that influence cerebral blood flow have been controlled for. Questions/purposes (1) What is the risk of intraoperative cerebral desaturation during shoulder surgery with the patient in the beach chair position when patients received combined general anesthesia and an interscalene block, and what other factors associated with intraoperative cerebral desaturation can be identified? (2) Is intraoperative cerebral desaturation associated with 24-hour cognitive decline? (3) What factors are associated with intraoperative hypotension? Methods Between April and December 2020, 51 patients underwent elective shoulder surgery in the beach chair position at one center. Nine patients were excluded: four patients refused to participate, two patients were unable to receive an interscalene brachial plexus block, and three patients were operated on in less than 70° upright position. A total of 42 patients (aged 63 ± 10 years, of whom 52% [22 of 42] were female) were prospectively recruited into this study. Each patient was diagnosed with a rotator cuff tear and underwent arthroscopic repair in the beach chair position, which was performed in an upright position of 70° to 80°. Near-infrared spectroscopy was used to monitor regional cerebral oxygen saturation. The mean arterial pressure was monitored and controlled so that it was more than 70 mmHg in patients without hypertension and within 20% from the baseline mean arterial pressure in patients with hypertension. All patients received the standardized anesthesia protocol, which consisted of an interscalene brachial plexus block and general anesthesia. Intraoperative cerebral desaturation was defined as a decrease in the regional cerebral oxygen saturation level of more than 20% from the baseline value that lasted longer than 15 seconds after induction of anesthesia. Patients’ clinical characteristics such as age, sex, BMI, preoperative hemoglobin level, preexisting medical conditions, and continuing antihypertensive medications on the morning of surgery were analyzed to identify the association with intraoperative cerebral desaturation. We used the Montreal Cognitive Assessment to assess cognitive function at preoperative and 24 hours postoperative. Episodes of hypotension and its treatment after maximum head elevation were recorded. The patients’ clinical characteristics were analyzed to determine their association with hypotensive events. Results In this study, intraoperative cerebral desaturation occurred in 43% (18 of 42) of patients, and female sex was identified as an associated risk (odds ratio 4.3 [95% confidence interval 1.2 to 16.2]; p = 0.03). The median (interquartile range) duration of intraoperative cerebral desaturation was 19 minutes (5 to 38). There was no association between intraoperative cerebral desaturation and 24-hour postoperative cognitive decline (OR 0.6 [95% CI 0.1 to 2.4]; p = 0.44). Risk factors for intraoperative hypotension were a history of hypertension, regardless of whether or not the patient took antihypertensive drugs on the morning of surgery (OR 4.9 [95% CI 1.3 to 18.1]; p = 0.02), and dyslipidemia (OR 4.3 [95% CI 1.2 to 16.3]; p = 0.03). Conclusion The intraoperative cerebral desaturation risk in the beach chair position was high. Female sex was an intraoperative cerebral desaturation risk factor. However, there was no association between intraoperative cerebral desaturation and postoperative cognitive decline. Patients with hypertension and dyslipidemia are at risk of intraoperative hypotension after positioning. Further large-scale studies are required to identify intraoperative cerebral desaturation–associated adverse neurologic outcome. Level of Evidence Level II, therapeutic study.

show abstract

“…Intraoperative hypotension (IOH) is frequent and multifactorial ( Table 1 ) [ 1 , 2 , 3 ]. The Perioperative Quality Initiative (POQI) consensus statement on intraoperative blood pressure (BP), risks and outcomes for elective non-cardiac surgery has warned that there is increasing evidence that even brief durations of hypotension, regardless of its origin, are harmful [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

Investigating Association between Intraoperative Hypotension and Postoperative Neurocognitive Disorders in Non-Cardiac Surgery: A Comprehensive Review

Krzych

Pluta

Putowski

et al. 2020

JCM

View full text Add to dashboard Cite

Postoperative delirium (POD) and postoperative cognitive decline (deficit) (POCD) are related to a higher risk of postoperative complications and long-term disability. Pathophysiology of POD and POCD is complex, elusive and multifactorial. Intraoperative hypotension (IOH) constitutes a frequent and vital health hazard in the perioperative period. Unfortunately, there are no international recommendations in terms of diagnostics and treatment of neurocognitive complications which may arise from hypotension-related hypoperfusion. Therefore, we performed a comprehensive review of the literature evaluating the association between IOH and POD/POCD in the non-cardiac setting. We have concluded that available data are quite inconsistent and there is a paucity of high-quality evidence convincing that IOH is a risk factor for POD/POCD development. Considerable heterogeneity between studies is the major limitation to set up reliable recommendations regarding intraoperative blood pressure management to protect the brain against hypotension-related hypoperfusion. Further well-designed and effectively-performed research is needed to elucidate true impact of intraoperative blood pressure variations on postoperative cognitive functioning.

show abstract

A retrospective cohort analysis for the risk factors of intraoperative hypotension

Cited by 15 publications

References 18 publications

Relationship among Preoperative, Pre and Postinduction Blood Pressure in Normotensive and Hypertensive Patients

Relationship among Preoperative, Pre and Postinduction Blood Pressure in Normotensive and Hypertensive Patients

What Is the Risk of Intraoperative Cerebral Oxygen Desaturation in Patients Undergoing Shoulder Surgery in the Beach Chair Position?

Investigating Association between Intraoperative Hypotension and Postoperative Neurocognitive Disorders in Non-Cardiac Surgery: A Comprehensive Review

Contact Info

Product

Resources

About