Arterial stiffness as a risk factor for hypotension during induction of general anesthesia

Abstract

IntroductionHypotension after induction of general anesthesia is identified as an independent factor in predicting adverse clinical outcomes. Preoperative evaluation of arterial stiffness could identify patients with an impaired vascular function and an altered hemodynamic response to induction to general anesthesia. Purpose of this study is to investigate the relationship between arterial stiffness and blood pressure variation during induction of general anesthesia.Material and methodsThis is a prospective observational study that included patients that underwent surgical procedures under general anesthesia. We used several SAP and MAP thresholds for defining hypotension. Both absolute thresholds and thresholds relative to a baseline blood pressure were chosen based on the most frequently used definitions. Patient carotid-femoral pulse wave velocity determination, preoperative preparation and induction of general anesthesia were standardized.ResultsOur study included 115 patients. Both univariate and multivariate analysis showed that carotid-femoral pulse wave velocity was significantly associated with post-induction hypotension when defined as systolic arterial pressure decrease of >30% or 40% from baseline or as mean arterial pressure decrease of >40% from baseline. Also, carotid-femoral pulse wave velocity was positively associated with duration of post-induction hypotension.ConclusionsPreoperative assessment of arterial stiffness identifies patients at risk of a pronounced decrease in blood pressure during induction of general anesthesia.

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“…Another study that investigated the incidence of postoperative kidney injury in 42,825 patients who underwent elective non-cardiac surgery demonstrated a significant association of the risk of acute kidney injury with the depth and duration of hypotension, both before (i.e., post-induction) and after surgical incision ( Maheshwari et al, 2018 ). Accordingly, a number of studies have attempted to identify the risk factors for hypotension after anesthetic induction ( Südfeld et al, 2017 ; Jor et al, 2018 ; Siriopol et al, 2021 ; Sutthibenjakul and Chatmongkolchart, 2021 ; Tarao et al, 2021 ). Taking into account the high incidence of hypotension after induction of anesthesia ( Reich et al, 2005 ; Jor et al, 2018 ; Khan et al, 2020 ; Tarao et al, 2021 ), there is a serious concern over its prevention by modifying the pharmacological strategies.…”