Risk factors including preoperative echocardiographic parameters for post-induction hypotension in general anesthesia. Issue 3 (September 2021)

• Record Type: Journal Article
• Authors: Tarao, Kentaroh; Daimon, Masao; Son, Kyongsuk; Nakanishi, Koki; Nakao, Tomoko; Suwazono, Yasushi; Isono, Shiroh
• Is Part Of: Journal of cardiology. Volume 78:Issue 3(2021)
• Page Start: 230
• Page End: 236
• Publication Date: 2021-09
• Subjects: General anesthesia -- Hypotension -- Echocardiography -- Regional wall motion abnormality; Cardiology -- Periodicals; 616.12
• DOI: 10.1016/j.jjcc.2021.03.010
• Languages: English
• ISSNs: 0914-5087

Abstract

Highlights: Post-induction hypotension is associated with poor postoperative prognosis. Preoperative regional wall motion abnormality is a risk factor for hypotension at induction. Preoperative echocardiography may predict intraoperative hypotension in high-risk patients. Abstract: Background: Severe hypotension immediately after induction of general anesthesia (post-induction hypotension) is a common complication and is associated with a poor postoperative outcome. We hypothesized that post-induction hypotension results from cardiac dysfunction which can be assessed by preoperative echocardiography. Methods: We retrospectively enrolled 200 patients who had undergone elective surgery within 6 months after preoperative transthoracic echocardiography. The incidence of post-induction hypotension identified from anesthesia records was defined as a decrease in mean blood pressure to ≤50 mmHg after injection of induction anesthetics prior to surgery. Logistic regression analysis of patient characteristics and echocardiographic variables was used to identify the independent factors for post-induction hypotension. Results: Post-induction hypotension was found in 63 of the 200 cases (incidence 32%). Independent risk factors for post-induction hypotension were the presence of a regional wall motion abnormality (RWMA) [odds ratio (OR), 6.65.; 95% confidence interval (CI), 1.76 - 25.10], an elevated E/e' (OR, 1.13; 95% CI, 1.00 - 1.28), female gender (OR, 3.61; 95% CI, 1.37 - 9.56), and the use of an angiotensin II receptor blocker (OR, 3.17; 95% CI, 1.12 - 8.96). Conclusions: Assessment of RWMA and E/e' with preoperative transthoracic echocardiography might be helpful for stratification of patients at a risk of post-induction hypotension in general anesthesia.