Mechanisms contributing to hypotension after anesthetic induction with sufentanil, propofol, and rocuronium: a prospective observational study

Abstract

It remains unclear whether reduced myocardial contractility, venous dilation with decreased venous return, or arterial dilation with reduced systemic vascular resistance contribute most to hypotension after induction of general anesthesia. We sought to assess the relative contribution of various hemodynamic mechanisms to hypotension after induction of general anesthesia with sufentanil, propofol, and rocuronium. In this prospective observational study, we continuously recorded hemodynamic variables during anesthetic induction using a finger-cuff method in 92 non-cardiac surgery patients. After sufentanil administration, there was no clinically important change in arterial pressure, but heart rate increased from baseline by 11 (99.89% confidence interval: 7 to 16) bpm (P < 0.001). After administration of propofol, mean arterial pressure decreased by 23 (17 to 28) mmHg and systemic vascular resistance index decreased by 565 (419 to 712) dyn*s*cm−5*m2 (P values < 0.001). Mean arterial pressure was < 65 mmHg in 27 patients (29%). After propofol administration, heart rate returned to baseline, and stroke volume index and cardiac index remained stable. After tracheal intubation, there were no clinically important differences compared to baseline in heart rate, stroke volume index, and cardiac index, but arterial pressure and systemic vascular resistance index remained markedly decreased. Anesthetic induction with sufentanil, propofol, and rocuronium reduced arterial pressure and systemic vascular resistance index. Heart rate, stroke volume index, and cardiac index remained stable. Post-induction hypotension therefore appears to result from arterial dilation with reduced systemic vascular resistance rather than venous dilation or reduced myocardial contractility.

Effect of Preanesthetic Fluid Loading on Postinduction Hypotension and Advanced Cardiac Parameters in Patients with Chronic Compressive Cervical Myelopathy: A Randomized Controlled Trial

“…A recent observational study in noncardiac patients demonstrated decrease in systemic vascular resistance (SVR) as a factor contributing to the development of postinduction hypotension. 9 Another study showed that stroke volume variation (SVV) before anesthetic induction predicts postinduction hypotension. 10 A decrease in cardiac index (CI) seen with induction agents such as propofol and etomidate also contributes to postinduction hypotension.…”

Hypotension during propofol sedation for colonoscopy: a retrospective exploratory analysis and meta-analysis

“…5 However, propofol decreases systemic vascular resistance and is associated with hypotension during and after induction of anaesthesia. 6,7 Colonoscopy is a high-volume investigation 8 usually performed under procedural sedation. In a Melbourne series of 2132 patients having endoscopy (1767 elective; 365 emergencies; median age 60 yr; 42% ASA physical status 3e5), 98% received propofol.…”

“… 5 However, propofol decreases systemic vascular resistance and is associated with hypotension during and after induction of anaesthesia. 6 , 7 …”

Observer’s Assessment of Alertness/Sedation-based titration reduces propofol consumption and incidence of hypotension during general anesthesia induction: A randomized controlled trial

“…33,34 Propofol used for anesthesia induction can cause a dose-dependent decrease in arterial blood pressure and cardiac output. 35,36 We found that the titrated group has a more stable hemodynamic profile than the conventional group. We performed real-time monitoring of the invasive blood pressure to facilitate prompt monitoring and correction of hypotension.…”