Association of elevated preoperative blood pressure with preincision hypotension in pediatric surgical patients

Abstract

Summary Introduction High blood pressure (BP) in childhood is associated with left ventricular hypertrophy and abnormal vascular reactivity even in apparently healthy children. This study examined the prevalence of high BP in children undergoing elective noncardiac operations. We also determined the association of preoperative high BP with preincision hypotension (PIH). Methods This was a retrospective cohort study that used clinical and anthropometric data on children aged 3–17 years who underwent elective, noncardiac operations from January 2006 to January 2014. Preoperative blood pressure (BP) was used to stratify children into three categories: normal BP (systolic and diastolic BP below the 90th percentile), prehypertension (systolic and/or diastolic BP ≥90th percentile but <95th percentile or if the BP exceeds 120/80 mmHg even if it is below the 90th percentile), and hypertension (systolic and/or diastolic BP ≥95th percentile). Multivariable logistic regression analysis was used to calculate adjusted odds ratios for PIH using age, gender, body mass index (BMI), and BP categories as covariates. Results Among 35832 children, the overall prevalence of prehypertension, hypertension, and hypertension by adult standards were 16.4%, 6.8%, and 3.3%, respectively. Overweight and obese children had higher rates of elevated BP. Presence of elevated baseline BP, high BMI category, and presence of OSA diagnosis were independent predictors of multiple episodes of PIH in a logistic regression model. Conclusion In children, preoperative high BP is an independent predictor of PIH. Although the longtime consequences of high BP are well known, this report provides the first intraoperative evidence of adverse event associated with preoperative high BP in children. Mechanisms underlying this hypotensive response are unclear.

Hormonal Blood Pressure Regulation during General Anesthesia Using a Standardized Propofol Dosage in Children and Adolescents Seems Not to Be Affected by Body Weight

“…We found a moderate positive correlation between patients’ BMI and preoperative systolic blood pressure (ρ = 0.452, p < 0.001). This result is in accordance with previous investigations, which in the meantime have been able to prove a corresponding connection [ 23 , 24 , 25 ]. In addition to the BMI, other factors such as the hip/waist circumference or body shape index are increasingly being examined, which also show a positive correlation and a cardiovascular risk [ 26 , 27 ].…”

“…This is especially true since obese children seem to be prone to relevant hypotension after anesthetic induction (preincision hypotension) [ 6 , 12 , 24 ]. By adjusting the dose of propofol to induce anesthesia in overweight and obese patients, no significant difference in the proportion of hypotension was found between the two groups [ 11 ].…”

Association between BMI z-score and postinduction hypotension in Chinese children undergoing oral surgery: A cross-sectional study

“…Although we employ a rigorous statistical analysis, increasing the observed population might make our study more convincing. Finally, a study by Stewart M et al pointed out that elevated baseline BP is a risk factor independent of intraoperative hypotension in children [20]. Our results indicate that baseline blood pressure is not signi cantly associated with postinduction hypotension, perhaps because we de ned hypotension using an absolute age-based threshold rather than a relative one, which we believe increases the stability of the observations and is more appropriate for cross-sectional comparisons between similar studies.…”