Management of hypotension after general anaesthesia induction - multicenter questionnaire study

Česká verzia

Authors: O.- Jor ^{1 3}; T. Vymazal ⁴; O. Klementová ⁵; L. Zach ⁶; J. Čapková ⁷; T. Pařízek ⁸; M. Pauliny ⁹; K. Bezděk ¹⁰; M. Litschmannová ¹¹; J. Máca ^1,2; P. Ševčík ^1,2; J. Firment ⁷; V. Černý ^3,8,12,13
Authors place of work: Klinika anesteziologie, resuscitace a intenzivní medicíny, Fakultní nemocnice Ostrava ¹; Katedra intenzivní medicíny a forenzních oborů, Lékařská fakulta, Ostravská univerzita v Ostravě ²; Klinika anesteziologie, resuscitace a intenzivní medicíny, Lékařská fakulta v Hradci Králové, Univerzita Karlova ³; Klinika anesteziologie, resuscitace a intenzivní medicíny, 2. lékařská fakulta, Univerzita Karlova a Fakultní nemocnice v Motole ⁴; Klinika anesteziologie, resuscitace a intenzivní medicíny, Fakultní nemocnice Olomouc ⁵; Klinika anesteziologie, resuscitace a intenzivní medicíny, Ústřední vojenská nemocnice – Vojenská fakultní nemocnice Praha ⁶; Klinika anestéziológie a intenzívnej medicíny, Univerzitná nemocnica L. Pasteura Košice ⁷; Klinika anesteziologie, perioperační a intenzivní medicíny, Masarykova nemocnice v Ústí nad Labem ⁸; Klinika anestéziológie a intenzívnej medicíny, Univerzitná nemocnica Bratislava ⁹; Anesteziologicko-resuscitační oddělení, Nemocnice Nový Jičín a. s. ¹⁰; Katedra aplikované matematiky, Fakulta elektrotechniky a informatiky, Vysoká škola báňská – Technická univerzita Ostrava ¹¹; Centrum pro výzkum a vývoj, Fakultní nemocnice Hradec Králové ¹²; Department of Anesthesia, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, Kanada ¹³
Published in the journal: Anest. intenziv. Med., 30, 2019, č. 3-4, s. 119-125
Category:

Summary

Objective: The aim of our study was to assess the management of hypotension after general anaesthesia induction (GAIH).

Design: Multicenter questionnaire study.

Setting: Eight different size anaesthesiology departments located in the Czech or Slovak Republics.

Materials and methods: The respondents responded to three identification questions (workplace, length of practice, specialized competence) and ten GAIH management questions in our online questionnaire. Simple descriptive statistics describing the representation of the respondents' answers in absolute and relative terms were used. Normalized entropy (H) was used to assess the variability of responses.

Results: A fully completed questionnaire was obtained from 172 respondents. The highest rate of variability was observed in question 1.: “As the baseline blood pressure value (BP), to which I compare other BP values, I consider…” H = 0.966. The lowest response variability rate was observed in question 4.: “As hypotension, I consider the decrease of BP…” H = 0.07).

Conclusion: Our results indicate high variability of GAIH management among anaesthetists.

Keywords:

Hypotension – general anaesthesia induction – haemodynamics

Zdroje

1. Südfeld S, Brechnitz S, Wagner JY, et al. Post-induction hypotension and early intraoperative hypotension associated with general anaesthesia. Br J Anaest. 2017;119:57–64.

2. Ida M, Katsuhiro K, Masato I, et al. Retrospective evaluation of predictors and frequency of hypotension in hypertensive patients after induction of general anesthesia. Masui. Jpn J Anesth. 2014;63:614–618.

3. Jor O, Maca J, Koutna J, et al. Hypotension after induction of general anesthesia: occurrence, risk factors, and therapy. A prospective multicentre observational study. J Anesth. 2018;32:673–680.

4. Kawasaki S, Chikako K, Shoji T, Sumio H. Prediction of hemodynamic fluctuations after induction of general anesthesia using propofol in non-cardiac surgery: a retrospective cohort study. BMC Anesthesiol. 2018;18:167.

5. Green R, Butler M. Postintubation hypotension in general anesthesia: a retrospective analysis. J Intensive Care Med. 2016;31:667–675.

6. Reich DL, Hossain S, Krol M, et al. Predictors of hypotension after induction of general anesthesia. Anesth Analg. 2005;101:622–628.

7. Bijker J, Persoon S, Peelen LM, et al. Intraoperative hypotension and perioperative ischemic stroke after general surgery. Anesthesiology. 2012;116:658–664.

8. Singh A, Antognini JF. Perioperative hypotension and myocardial ischemia: diagnostic and therapeutic approaches. Ann Cardiac Anaesth. 2011;14:127–132.

9. Monk TG, Bronsert MR, Henderso WG, et al. Association between intraoperative hypotension and hypertension and 30-day postoperative mortality in noncardiac surgery. Anesthesiology. 2015;123: 307–309.

10. Hirsch J, Depalma G, Tsai TT, et al. Impact of intraoperative hypotension and blood pressure fluctuations on early postoperative delirium after non-cardiac surgery. Brit J Anaesth. 2015; 115: 418–426.

11. Sun LY, Wijeysundera DN, Tait GA, Beattie WS. Association of intraoperative hypotension with acute kidney injury after elective noncardiac surgery. Anesthesiology. 2015;123:515–523.

12. Reich DL, Bodian CA, Krol M, et al. Intraoperative hemodynamic predictors of mortality, stroke, and myocardial infarction after coronary artery bypass surgery. Anesth Analg. 1999;89:814–822.

13. Mascha EJ, Yang D, Weiss S, Sessler DI. Intraoperative mean arterial pressure variability and 30-day mortality in patients having noncardiac surgery. Anesthesiology. 2015;:79–81.

14. Salmasi V, Mascha EJ, Singh A, et al. Thresholds, and acute kidney and myocardial injury after noncardiac surgery a retrospective cohort analysis. Anesthesiology. 2017;126:47–55.

15. Von Elm E, Altman DG, Egger P, et al. The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol. 2008;61:344–349.

16. Edwards P. Questionnaires in clinical trials: guidelines for optimal design and administration. Trials. 2010;11:2.

17. Bijker JB, Van Klei WA, Kappen TH, et al. Incidence of intraoperative hypotension as a function of the chosen definition. Surv Anesthesiol. 2008;52:237–238.

18. Salmasi V, Maheshwari K, Yang D, et al. Relationship between intraoperative hypotension, defined by either reduction from baseline or absolute thresholds, and acute kidney and myocardial injury after noncardiac surgery. Anesthesiology. 2017;126:47–55.

19. Masjedi M, Zand F, Kazemi AP, Hoseinipoura A. Prophylactic effect of ephedrine to reduce hemodynamic changes associated with anesthesia induction with propofol and remifentanil. J Anaesthesiol Clin Pharmacol. 2014;30:217–221.

20. Nissen P, Brassard P, Jørgensen TB, Secher NH. Phenylephrine but not ephedrine reduces frontal lobe oxygenation following anesthesia-induced hypotension. Neurocrit Care. 2010;12:17–23.

21. Turner RJ, Gatt SP, Kam PC, et al. Administration of a crystalloid fluid preload does not prevent the decrease in arterial blood pressure after induction of anaesthesia with propofol and fentanyl. Brit J Anaesth. 1998;80:737–741.

22. Darvall J, Vijayakumar R, Leslie K. Prewarming neurosurgical patients to minimize hypotension on induction of anesthesia: a randomized trial. Can J Anesth. 2016;63:577–583.