Predictors of hypotension during anesthesia induction in patients with hypertension on medication: a retrospective observational study

Hojo, Takayuki; Kimura, Yukifumi; Shibuya, Makiko; Fujisawa, Toshiaki

doi:10.1186/s12871-022-01899-9

Cited by 13 publications

(9 citation statements)

References 34 publications

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“…In this study, the period of assessment of postinduction hypotension was 16 min which is within the range of earlier studies assessing the postinduction hypotension (10–30 min) [ 3 , 36 – 38 ]. Furthermore, longer assessment period would lead to unnecessary delay of an emergency surgery and shorter assessment period would not allow for proper hemodynamic assessment.…”

Section: Discussionmentioning

confidence: 71%

Comparison of different ratios of propofol-ketamine admixture in rapid-sequence induction of anesthesia for emergency laparotomy: a randomized controlled trial

Elsherbiny,

Hasanin,

Kasem

et al. 2023

BMC Anesthesiol

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Background We aimed to compare the hemodynamic effect of two ratios of propofol and ketamine (ketofol), namely 1:1 and 1:3 ratios, in rapid-sequence induction of anesthesia for emergency laparotomy. Methods This randomized controlled study included adult patients undergoing emergency laparotomy under general anesthesia. The patients were randomized to receive either ketofol ratio of 1:1 (n = 37) or ketofol ratio of 1:3 (n = 37). Hypotension (mean arterial pressure < 70 mmHg) was managed by 5-mcg norepinephrine. The primary outcome was total norepinephrine requirements during the postinduction period. Secondary outcomes included the incidence of postinduction hypotension, and the intubation condition (excellent, good, or poor). Results Thirty-seven patients in the ketofol-1:1 and 35 patients in the ketofol 1:3 group were analyzed. The total norepinephrine requirement was less in the ketofol-1:1 group than in the ketofol-1:3 group, P-values: 0.043. The incidence of postinduction hypotension was less in the ketofol-1:1 group (4 [12%]) than in ketofol-1:3 group (12 [35%]), P-value 0.022. All the included patients had excellent intubation condition. Conclusion In patients undergoing emergency laparotomy, the use of ketofol in 1:1 ratio for rapid-sequence induction of anesthesia was associated with less incidence of postinduction hypotension and vasopressor consumption in comparison to the 1:3 ratio with comparable intubation conditions. Clinical trial registration NCT05166330. URL: https://clinicaltrials.gov/ct2/show/NCT05166330.

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Section: Discussionmentioning

confidence: 71%

Comparison of different ratios of propofol-ketamine admixture in rapid-sequence induction of anesthesia for emergency laparotomy: a randomized controlled trial

Elsherbiny,

Hasanin,

Kasem

et al. 2023

BMC Anesthesiol

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“…Some antihypertensive drugs are reported to contribute to hypotension during anesthesia [ 28 ]. Hojo et al recently observed that ARBs/angiotensin-converting enzyme inhibitors (ACEIs) with a long half-life and β blockers, but not ARBs/ACEIs with a short–middle half-life and Ca channel blockers, increased the risk of hypotension during anesthesia [ 29 ]. Antihypertensive drugs, including ARBs with a long half-life, may have contributed to the hypotension in this study.…”

Section: Discussionmentioning

confidence: 99%

Comparison of hemodynamics during induction of general anesthesia with remimazolam and target-controlled propofol in middle-aged and elderly patients: a single-center, randomized, controlled trial

et al. 2023

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Background Remimazolam confers a lower risk of hypotension than propofol. However, no studies have compared the efficacy of remimazolam and propofol administered using target-controlled infusion (TCI). This study aimed to investigate hemodynamic effects of remimazolam and target-controlled propofol in middle-aged and elderly patients during the induction of anesthesia. Methods Forty adults aged 45–80 years with the American Society of Anesthesiologists Physical Status 1–2 were randomly assigned to remimazolam or propofol group (n = 20 each). Patients received either remimazolam (12 mg/kg/h) or propofol (3 μg/mL, TCI), along with remifentanil for inducing anesthesia. We recorded the blood pressure, heart rate (HR), and estimated continuous cardiac output (esCCO) using the pulse wave transit time. The primary outcome was the maximum change in mean arterial pressure (MAP) after induction. Secondary outcomes included changes in HR, cardiac output (CO), and stroke volume (SV). Results MAP decreased after induction of anesthesia in both groups, without significant differences between the groups (− 41.1 [16.4] mmHg and − 42.8 [10.8] mmHg in remimazolam and propofol groups, respectively; mean difference: 1.7 [95% confidence interval: − 8.2 to 4.9]; p = 0.613). Furthermore, HR, CO, and SV decreased after induction in both groups, without significant differences between the groups. Remimazolam group had significantly shorter time until loss of consciousness than propofol group (1.7 [0.7] min and 3.5 [1.7] min, respectively; p < 0.001). However, MAP, HR, CO, and SV were not significantly different between the groups despite adjusting time until loss of consciousness as a covariate. Seven (35%) and 11 (55%) patients in the remimazolam and propofol groups, respectively, experienced hypotension (MAP < 65 mmHg over 2.5 min), without significant differences between the groups (p = 0.341). Conclusions Hemodynamics were not significantly different between remimazolam and target-controlled propofol groups during induction of anesthesia. Thus, not only the choice but also the dose and usage of anesthetics are important for hemodynamic stability while inducing anesthesia. Clinicians should monitor hypotension while inducing anesthesia with remimazolam as well as propofol. Trial registration UMIN-CTR (UMIN000045612).

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“…However, a 2018 systematic review confirmed that continued perioperative use of ARB/ACEI was associated with an increased incidence of IOH ( 37 ). A 2022 study found that regular use of ARB/ACEI with a long half-life increases the risk of hypotension during anesthesia induction in hypertensive patients, even after 24 h of withdrawal before surgery, so especially ARB/ACEI with a longer half-life than 24 h should be carefully adjusted by clinicians considering the pros and cons of withdrawal ( 38 ) and all perioperative risk factors ( 39 ). This was confirmed in a 2020 case of a patient who developed refractory hypotension during general anesthesia after withholding Telmisartan ( 40 ).…”

Section: Discussionmentioning

confidence: 99%

Bibliometric and visual analysis of intraoperative hypotension from 2004 to 2022

Wang,

Liu,

Bai

et al. 2023

Front. Cardiovasc. Med.

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BackgroundIntraoperative hypotension (IOH) is a common complication occurring in surgical practice. This study aims to comprehensively review the collaboration and impact of countries, institutions, authors, journals, keywords, and critical papers on intraoperative hypotension from the perspective of bibliometric, and to evaluate the evolution of knowledge structure clustering and identify research hotspots and emerging topics.MethodsArticles and reviews related to IOH published from 2004 to 2022 were retrieved from the Web of Science Core Collection. Bibliometric analyses and visualization were conducted on Excel, CiteSpace, VOSviewer, and Bibliometrix (R-Tool of R-Studio).ResultsA total of 1,784 articles and reviews were included from 2004 to 2022. The number of articles on IOH gradually increased in the past few years, and peaked in 2021. These publications were chiefly from 1,938 institutions in 40 countries, led by America and China in publications. Sessler Daniel I published the most papers and enjoyed the highest number of citations. Analysis of the journals with the most outputs showed that most journals concentrated on perioperative medicine and clinical anesthesiology. Delirium, acute kidney injury and vasoconstrictor agents are the current and developing research hotspots. The keywords “Acute kidney injury”, “postoperative complication”, “machine learning”, “risk factors” and “hemodynamic instability” may also become new trends and focuses of the near future research.ConclusionThis study uses bibliometrics and visualization methods to comprehensively review the research on intraoperative hypotension, which is helpful for scholars to better understand the dynamic evolution of IOH and provide directions for future research.

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Predictors of hypotension during anesthesia induction in patients with hypertension on medication: a retrospective observational study

Cited by 13 publications

References 34 publications

Comparison of different ratios of propofol-ketamine admixture in rapid-sequence induction of anesthesia for emergency laparotomy: a randomized controlled trial

Comparison of different ratios of propofol-ketamine admixture in rapid-sequence induction of anesthesia for emergency laparotomy: a randomized controlled trial

Comparison of hemodynamics during induction of general anesthesia with remimazolam and target-controlled propofol in middle-aged and elderly patients: a single-center, randomized, controlled trial

Bibliometric and visual analysis of intraoperative hypotension from 2004 to 2022

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