Common clinical thresholds of intraoperative hypotension and 30‐day mortality following surgery: A retrospective cohort study

Dony, Philippe; Seidel, Laurence; Pirson, Michael; Haller, Guy

doi:10.1111/aas.13670

Cited by 10 publications

(10 citation statements)

References 40 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The incidence of hypotensive events defined by relative decreases of MAP by 20% or 30% did not differ between the treatment groups, which may be because there is only a weak correlation between first pre‐induction and daytime MAP [28]. Furthermore, relative decreases in systolic blood pressure are not associated with postoperative 30‐day mortality [29]. A final consideration pertains to the dosing of remifentanil, which was higher in patients who received remimazolam than those who received propofol.…”

Section: Discussionmentioning

confidence: 99%

Anaesthetic efficacy and postinduction hypotension with remimazolam compared with propofol: a multicentre randomised controlled trial

Fechner,

El‐Boghdadly,

Spahn

et al. 2024

Anaesthesia

View full text Add to dashboard Cite

SummaryRemimazolam, a short‐acting benzodiazepine, may be used for induction and maintenance of total intravenous anaesthesia, but its role in the management of patients with multiple comorbidities remains unclear. In this phase 3 randomised controlled trial, we compared the anaesthetic efficacy and the incidence of postinduction hypotension during total intravenous anaesthesia with remimazolam vs. propofol. A total of 365 patients (ASA physical status 3 or 4) scheduled for elective surgery were assigned randomly to receive total intravenous anaesthesia with remimazolam (n = 270) or propofol (n = 95). Primary outcome was anaesthetic effect, quantified as the percentage of time with Narcotrend® Index values ≤ 60, during surgery (skin incision to last skin suture), with a non‐inferiority margin of ‐10%. Secondary outcome was the incidence of postinduction hypotensive events. Mean (SD) percentage of time with Narcotrend Index values ≤ 60 during surgery across all patients receiving remimazolam (93% (20.7)) was non‐inferior to propofol (99% (4.2)), mean difference (97.5%CI) ‐6.28% (‐8.89–infinite); p = 0.003. Mean (SD) number of postinduction hypotension events was 62 (38.1) and 71 (41.1) for patients allocated to the remimazolam and propofol groups, respectively; p = 0.015. Noradrenaline administration events (requirement for a bolus and/or infusion) were also lower in patients allocated to remimazolam compared with propofol (14 (13.5) vs. 20 (14.6), respectively; p < 0.001). In conclusion, in patients who were ASA physical status 3 or 4, the anaesthetic effect of remimazolam was non‐inferior to propofol.

show abstract

Section: Discussionmentioning

confidence: 99%

Anaesthetic efficacy and postinduction hypotension with remimazolam compared with propofol: a multicentre randomised controlled trial

Fechner,

El‐Boghdadly,

Spahn

et al. 2024

Anaesthesia

View full text Add to dashboard Cite

show abstract

“…Currently, the duration and extent of perioperative episodes of hypotension causing postoperative complications are encouraging scientific investigations. Several previous studies have discussed the impact of hypotensive events during anesthesia administration on developing complications [ 6 , 7 , 8 , 9 , 11 , 14 , 15 ]; for instance, Vernooij et al conducted a study involving 10,432 patients who underwent non-cardiac surgery. In this study, an increased number of episodes ((OR) = 1.02, p < 0.001) and a longer total duration ((OR) = 1.01, p < 0.001) of relative MAP decreasing by 20% from the baseline were significantly associated with an elevated risk of postoperative myocardial injury [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

“…In contrast to ASA classification, which is an intrinsic factor that exists pre-operatively, hemodynamic instability seems to be an extrinsic factor that can be treated intraoperatively. Although anesthesiologists treat hemodynamic instability, the threshold and duration of hemodynamic fluctuations remain an issue, generating discussions about whether the postoperative complications related to hemodynamic instability cause the dysfunction of major organs or even mortality [ 6 , 9 , 11 ].…”

Section: Introductionmentioning

confidence: 99%

Intraoperative Hemodynamic Instability and Higher ASA Classification Increase the Risk of Developing Non-Surgical Complications following Orthopedic Surgeries

Hsu,

Chen,

et al. 2024

JCM

View full text Add to dashboard Cite

(1) Background: Either pre-operative physical status or unstable hemodynamic changes has been reported to play a potential role in causing vital organ dysfunction. Therefore, we intended to investigate the impact of the American Society of Anesthesiologist (ASA) classification and intraoperative hemodynamic instability on non-surgical complications following orthopedic surgery. (2) Methods: We collected data on 6478 patients, with a mean age of 57.3 ± 16, who underwent orthopedic surgeries between 2018 and 2020. The ASA classification and hemodynamic data were obtained from an anesthesia database. Non-surgical complications were defined as a dysfunction of the vital organs. (3) Results: ASA III/IV caused significantly higher odds ratios (OR) of 17.49 and 40.96, respectively, than ASA I for developing non-surgical complications (p < 0.001). Non-surgical complications were correlated with a 20% reduction in systolic blood pressure (SBP), which was intraoperatively compared to the pre-operative baseline ((OR) = 1.38, p = 0.02). The risk of postoperative complications increased with longer durations of SBP < 100 mmHg, peaking at over 20 min ((OR) = 1.33, p = 0.34). (4) Conclusions: Extended intraoperative hypotension and ASA III/IV caused a significantly higher risk of adverse events occurring within the major organs. The maintenance of hemodynamic stability prevents non-surgical complications after orthopedic surgeries.

show abstract

“…Preoxygenation or peri-intubation oxygenation techniques such as oxygen administration using a face mask, highor low-flow nasal cannula, and gentle mask ventilation (as opposed to apnoeic oxygenation) have recently been recommended to reduce the risk of hypoxaemia during induction of general anaesthesia, especially in the setting of emergency Caesarean delivery. 3,4 Clinical studies comparing methods for peri-induction oxygen administration in pregnant women are challenging to perform because of ethical concerns. It is difficult to obtain informed consent for study participation in the setting of emergency Caesarean delivery.…”

Section: Discussionmentioning

confidence: 99%

‘If you don't take a temperature, you can't find a fever’: relevance to continuous arterial pressure monitoring

Lier

Bouwman²,

Scheeren³

2022

British Journal of Anaesthesia

View full text Add to dashboard Cite

Common clinical thresholds of intraoperative hypotension and 30‐day mortality following surgery: A retrospective cohort study

Cited by 10 publications

References 40 publications

Anaesthetic efficacy and postinduction hypotension with remimazolam compared with propofol: a multicentre randomised controlled trial

Anaesthetic efficacy and postinduction hypotension with remimazolam compared with propofol: a multicentre randomised controlled trial

Intraoperative Hemodynamic Instability and Higher ASA Classification Increase the Risk of Developing Non-Surgical Complications following Orthopedic Surgeries

‘If you don't take a temperature, you can't find a fever’: relevance to continuous arterial pressure monitoring

Contact Info

Product

Resources

About