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Hypotension after induction of general anesthesia: occurrence, risk factors, and therapy. A prospective multicentre observational study

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Abstract

Background

Hypotension after induction of general anesthesia (GAIH) is common in anesthesiology practice and can impact outcomes.

Methods

In this prospective multicenter, cross-sectional, observational study, the hypotension was defined as a decrease in mean arterial pressure of > 30% compared to the first measurement in the operation theatre before general anesthesia (GA) induction. Blood pressure was measured immediately at the time of endotracheal intubation (TETI), at five (T5) and 10 (T10) minutes after. All subjects aged > 18 years undergoing elective non-cardiac surgery under GA were included. The goals were description of GAIH occurrence, the association of GAIH with selected comorbidities, chronic medications, and anesthetics with GAIH, and the type and efficacy of interventions used to correct hypotension.

Results

Data from 661 subjects, whose GA was induced with propofol and sufentanil, were analyzed. In 36.5% of subjects, GAIH was observed at ≥ 1 of the assessed time points. GAIH was present in 2.9% subjects at all time points. The probability of GAIH is raising with age, degree of hypertension at time of arrival to theatre and presence of diabetes. The type of volatile anesthetic was not associated with the occurrence of GAIH. The overall efficiency of interventions to correct hypotension was 94.4%. Bolus fluids were the most often used intervention and was 96.4% effective.

Conclusion

GAIH rate depends on age, degree of blood pressure decompensation prior the surgery, and presence of diabetes mellitus type II.

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Acknowledgements

Data collection costs were financed by the internal resources of each department. Statistical analyses were supported by the internal grant agency of VSB Technical University of Ostrava, Faculty of Electrical Engineering and Computer Science, Czech Republic, under the Project No. SP2017/56.

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Authors and Affiliations

  1. Department of Anesthesiology and Intensive Care Medicine, University Hospital Ostrava, 17. listopadu 1790, Poruba, 708 52, Ostrava, Czech Republic

    Ondrej Jor, Jan Maca, Pavel Sevcik & Petr Reimer

  2. Department of Anesthesiology, Perioperative Medicine and Intensive Care, J.E. Purkinje University, Masaryk Hospital, Usti nad Labem, Czech Republic

    Vladimir Cerny

  3. Department of Anesthesiology and Intensive Care Medicine, University Hospital Olomouc, Olomouc, Czech Republic

    Jirina Koutna

  4. Faculty of Medicine and Dentistry, Palacky University Olomouc, Olomouc, Czech Republic

    Jirina Koutna

  5. Department of Anesthesia and Resuscitation, Novy Jicin Hospital, Novy Jicin, Czech Republic

    Michaela Gemrotova

  6. Department of Anesthesiology and Intensive Care Medicine, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic

    Tomas Vymazal

  7. Department of Applied Mathematics, Technical University of Ostrava, Ostrava, Czech Republic

    Martina Litschmannova

  8. Department of Intensive Medicine and Forensic Studies, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic

    Jan Maca, Pavel Sevcik, Vera Mikulova & Michaela Trlicova

  9. Centrum for Research and Development, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic

    Vladimir Cerny

  10. Department of Anesthesiology and Intensive Care, Faculty of Medicine in Hradec Kralove, Charles University in Prague, Prague, Czech Republic

    Ondrej Jor & Vladimir Cerny

  11. Department of Anesthesia, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, NS, Canada

    Vladimir Cerny

Authors
  1. Ondrej Jor
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  2. Jan Maca
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  3. Jirina Koutna
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  4. Michaela Gemrotova
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  5. Tomas Vymazal
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  6. Martina Litschmannova
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  7. Pavel Sevcik
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  8. Petr Reimer
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  9. Vera Mikulova
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  10. Michaela Trlicova
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  11. Vladimir Cerny
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Contributions

OJ project design, coordination of data collection from Ostrava, writing manuscript. JM project design, language correction, writing manuscript. JK coordination of data collection from Olomouc, final manuscript check. MG coordination of data collection from Nový Jičín, final manuscript check. TV coordination of data collection from Praha, final manuscript check. ML project design, statistical analysis, final manuscript check. PŠ project design, supervision, final manuscript check. PR project design, writing manuscript. VM data management (Centers: Ostrava, Olomouc), final manuscript check. MT data management (Centers: Praha, Nový Jičín, Ústí nad Labem), final manuscript check. VČ project design, supervision, coordination of data collection from Ústí nad Labem, final manuscript check.

Corresponding author

Correspondence to Ondrej Jor.

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Conflict of interest

All authors declare that they have no conflict of interest.

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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 32, 673–680 (2018). https://doi.org/10.1007/s00540-018-2532-6

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  • DOI: https://doi.org/10.1007/s00540-018-2532-6

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