Prediction of hemodynamic fluctuations after induction of general anesthesia using propofol in non-cardiac surgery: a retrospective cohort study

Abstract

BackgroundAlthough propofol is a common anesthetic agent for the induction of general anesthesia, hemodynamic fluctuations are occasionally prominent during induction/intubation. The aims of this study were to determine the influential factors on enhanced hemodynamic fluctuation and to establish a prediction formula to quickly determine the dose of propofol to protect against hemodynamic fluctuations.MethodsThis retrospective cohort study patients (n = 2097) were 18 years or older. They underwent general anesthesia induction using propofol and orotracheal intubation for non-cardiac surgery at Kyushu University Hospital during April 2015 to March 2016. Preoperative patient clinical information was collected from anesthesia preoperative evaluation records. Intraoperative data were obtained from computerized anesthesia records. If patients’ post-induction mean arterial blood pressure (MAP) decreased or increased 30% or more from their pre-induction MAP, they were determined to have enhanced hemodynamic fluctuations. Unconditional logistic regression was used to assess the adjusted odds ratios (ORs) and 95% confidence intervals (CIs). Structural equation modeling (SEM) was conducted to simultaneously examine the direct and indirect effect (path coefficient = r) of potential variables.ResultsIn the SEM analysis, age was significantly associated with enhanced hemodynamic fluctuations (adjusted odds ratio = 1.008, 95% CI = 1.001–1.015, P = 0.03). Age (path coefficient (r) = − 0.0113, 95% CI = − 0.0126–0.010, P < 0.001), American Society of Anesthesiologists physical status (ASA-PS) (r = − 0.0788, 95% CI = − 0.1431–0.0145, P = 0.02), sex (r = 0.057, 95% CI = 0.0149–0.9906, P = 0.01), and fentanyl dose (r = 0.1087, 95% CI = 0.0707–0.1467, P < 0.001) influenced the dose of propofol in induction. The prediction formula of “Propofol dose (mg) = [2.374 – 0.0113 × age (year) – 0.0788 (if ASA-PS 3 or 4) + 0.057 (if female) + 0.1087 × fentanyl dose (μg/kg)] × body weight (kg)” was derived.ConclusionsAge was associated with hemodynamic fluctuations in induction. Although the prediction formula is considered to be acceptable, future studies validating whether it can decrease patients’ risk of enhanced hemodynamic fluctuations in clinical situations are necessary.

Outcomes of Transfemoral Transcatheter Aortic Valve Replacement Performed With General Anesthesia Using a Supraglottic Airway Versus Monitored Anesthesia Care

“…29,30 On the other hand, intraoperative hypotension may predispose negative outcomes such as stroke, AKI, MI, or patient demise. 28 In the present study, no differences in these outcomes were observed.…”

“…Predictably, vasopressor burden was higher in the GA-SGA group, a finding likely representing a well-established inherent limitation of GA because anesthetic agents often result in hemodynamic fluctuations secondary to inhibition of sympathetic outflow (particularly during induction). 28 Even though GA-SGA patients received more vasopressors, existing literature on this topic demonstrates that modest intraoperative use of vasopressors to combat hypotension preserves organ perfusion and tissue oxygenation without affecting mortality. 29,30 On the other hand, intraoperative hypotension may predispose negative outcomes such as stroke, AKI, MI, or patient demise.…”

Comparison of the combination of propofol and etomidate versus propofol or etomidate alone for induction of general anesthesia: a double-blind, randomized controlled trial

“…Hemodynamic fluctuation during the induction of GA is a common event and an important clinical consideration for anesthesiologists [1,8,18]. Jor and colleagues found that hypotension after induction of GA with propofol and sufentanil was observed at ≥1 of the assessed time points in 36.5% patients undergoing elective noncardiac surgery [3].…”

“…However, propofol and etomidate have different advantages and adverse effects. Propofol has been associated with injection pain, significant hemodynamic change (hypotension) during induction, and less postoperative nausea and vomiting (PONV) [8][9][10][11]. Etomidate has been associated with less pain during induction, and more stable hemodynamic, with increased myoclonic movements at induction and PONV incidence [12][13][14][15].…”

Implantation of subcutaneous defibrillator is feasible and safe with monitored anesthesia care

“…The perturbations in the hemodynamics are more commonly seen during GA . According to the best of our knowledge, there is no study directly comparing the hemodynamic effects of GA and MAC during implantation of S‐ICD.…”