Intraoperative Hypotension Increased Risk in the Oncological Patient

Shehata, Islam Mohammad; Elhassan, Amir; Munoz, David Alejandro; Bryan, Okereke; Cornett, Elyse M.; Varrassi, Giustino; Imani, Farnad; Kaye, Alan D.; Sehat-Kashani, Saloome; Urits, Ivan; Viswanath, Omar

doi:10.5812/aapm.112830

Cited by 6 publications

(4 citation statements)

References 46 publications

(47 reference statements)

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“…Moreover, the burden of cardiovascular risk factors and their prevalence increased over time [27]. In particular, cancer surgeries can be prolonged and procedurally complicated, carrying an increased risk of the procedure itself, such as significant blood loss, deep vein thrombosis, pressure sores, and respiratory or cardiovascular instability [28].…”

Section: Discussionmentioning

confidence: 99%

Individualized Perioperative Hemodynamic Management Using Hypotension Prediction Index Software and the Dynamics of Troponin and NTproBNP Concentration Changes in Patients Undergoing Oncological Abdominal Surgery

Cylwik,

Celińska-Spodar,

Dudzic

2024

JPM

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Introduction: Abdominal oncologic surgeries pose significant risks due to the complexity of the surgery and patients’ often weakened health, multiple comorbidities, and increased perioperative hazards. Hypotension is a major risk factor for perioperative cardiovascular complications, necessitating individualized management in modern anesthesiology. Aim: This study aimed to determine the dynamics of changes in troponin and NTproBNP levels during the first two postoperative days in patients undergoing major cancer abdominal surgery with advanced hemodynamic monitoring including The AcumenTM Hypotension Prediction Index software (HPI) (Edwards Lifesciences, Irvine, CA, USA) and their association with the occurrence of postoperative cardiovascular complications. Methods: A prospective study was conducted, including 50 patients scheduled for abdominal cancer surgery who, due to the overall risk of perioperative complications (ASA class 3 or 4), were monitored using the HPI software. Hypotension was qualified as at least one ≥ 1 min episode of a MAP < 65 mm Hg. Preoperatively and 24 and 48 h after the procedure, the levels of NTproBNP and troponin were measured, and an ECG was performed. Results: We analyzed data from 46 patients and found that 82% experienced at least one episode of low blood pressure (MAP < 65 mmHg). However, the quality indices of hypotension were low, with a median time-weighted average MAP < 65 mmHg of 0.085 (0.03–0.19) mmHg and a median of 2 (2–1.17) minutes spent below MAP < 65 mmHg. Although the incidence of perioperative myocardial injury was 10%, there was no evidence to suggest a relationship with hypotension. Acute kidney injury was seen in 23.9% of patients, and it was significantly associated with a number of episodes of MAP < 50 mmHg. Levels of NTproBNP were significantly higher on the first postoperative day compared to preoperative values (285.8 [IQR: 679.8] vs. 183.9 [IQR: 428.1] pg/mL, p < 0.001). However, they decreased on the second day (276.65 [IQR: 609.4] pg/mL, p = 0.154). The dynamics of NTproBNP were similar for patients with and without heart failure, although those with heart failure had significantly higher preoperative concentrations (435.9 [IQR: 711.15] vs. 87 [IQR: 232.2] pg/mL, p < 0.001). Patients undergoing laparoscopic surgery showed a statistically significant increase in NTproBNP. Conclusions: This study suggests that advanced HPI monitoring in abdominal cancer surgery effectively minimizes intraoperative hypotension with no significant NTproBNP or troponin perioperative dynamics, irrespective of preoperative heart failure.

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Section: Discussionmentioning

confidence: 99%

Individualized Perioperative Hemodynamic Management Using Hypotension Prediction Index Software and the Dynamics of Troponin and NTproBNP Concentration Changes in Patients Undergoing Oncological Abdominal Surgery

Cylwik,

Celińska-Spodar,

Dudzic

2024

JPM

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“…Maintaining lower blood pressure is linked to reduced blood loss and a clearer surgical field. Controlled hypotension, commonly defined as a 30% decrease in MAP, may vary due to reported cases of organ failure, including acute kidney injury, myocardial injury, and mortality during the procedure [35][36][37][38]. Zamani et al found that while both sedatives decreased bleeding during surgery, patients who received remifentanil experienced more pronounced outcomes [11].…”

Section: Discussionmentioning

confidence: 99%

Dexmedetomidine versus remifentanil in nasal surgery: a systematic review and meta-analysis

Janipour,

Bastaninejad,

mohebbi

et al. 2024

BMC Anesthesiol

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Background Nasal surgeries, addressing anatomical variations for form and function, require careful anesthesia administration, including dexmedetomidine and remifentanil. This meta-analysis evaluates their safety and efficacy variations in nasal surgeries, emphasizing patient comfort and optimal outcomes. Methods Four electronic databases (PubMed, Scopus, Web of Science, and CINAHL Complete) were searched for records in English. Studies that measure the effect of dexmedetomidine versus remifentanil on patients underwent nasal surgery were included. The Cochrane Collaboration’s tool was used to assess the quality of the included studies. A random-effect model was preferred and statistical analysis was performed by Stata software version 17. Results Out of an initial pool of 63 articles, five studies were selected for this analysis. All of these chosen studies were Randomized Controlled Trials (RCTs). The meta-analysis involved a total of 302 participants, with 152 in the remifentanil group and 150 in the dexmedetomidine group. The analysis aimed to compare the effects of Dexmedetomidine and Remifentanil on heart rate (HR) and mean arterial pressure (MAP) during surgery. Both groups exhibited similar MAP and HR, with the exception of a slightly lower HR in the remifentanil group at the 15th minute of surgery (Standardized Mean Difference: -0.24 [-0.83, 0.34]). Furthermore, when evaluating the impact of these medications on post-surgery outcomes, including pain levels, the use of pain relief medications, patient-surgeon satisfaction, agitation scores, and recovery time, no significant differences were observed between the two medications in any of these aspects. Conclusion In summary, the study compared Dexmedetomidine and Remifentanil in nasal surgeries anesthesia. No significant differences were found in heart rate, blood pressure, satisfaction, pain, agitation, or recovery time. The study had limitations, and future research should establish standardized protocols and consider various surgical factors.

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“…Intraoperative low cardiac output and hypotension disrupt perfusion to the kidney that potentially causes graft failure, as well as maintaining perfusion within normal autoregulation, decrease the risk of organ complications in high-risk cardiac and non-cardiac surgical patients ( 22 , 23 ). In perioperative and intensive care medicine, static parameters such as central venous pressure (CVP) or mean arterial blood pressure (MAP) have limitations as hemodynamic monitoring in high-risk surgical patients ( 24 ).…”

Section: Discussionmentioning

confidence: 99%

Comparison of Bioimpedance Versus Pulse Contour Analysis for Intraoperative Cardiac Index Monitoring in Patients Undergoing Kidney Transplantation

2021

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Background: Cardiac index (CI; cardiac output indexed to body surface area) is routinely measured during kidney transplant surgery. Bioimpedance cardiometry is a transthoracic impedance as the non-invasive alternative for hemodynamic monitoring, using semi-invasive uncalibrated pulse wave or contour (UPC) analysis. Objectives: We performed a cross-sectional observational study on 50 kidney transplant patients to compare the CI measurement agreement, concordance rate, and trending ability between bioimpedance and UPC analysis. Methods: For each patient, CI was measured by bioimpedance analysis (ICONTM) and UPC analysis (EV1000TM) devices at three time points: after induction, during incision, and at reperfusion. The device measurement accuracy was assessed by the bias value, limit of agreement (LoA), and percentage error (PE) using Bland-Altman analyses. Trending ability was assessed by angular bias and polar concordance through four-quadrant and polar plot analyses. Results: From each time point and pooled measurement, the correlation coefficients were 0.267, 0.327, 0.321, and 0.348. Bland-Altman analyses showed mean bias values of 1.18, 1.06, 1.48, and 1.30, LoA of -1.35 to 3.72, -1.39 to 3.51, -1.07 to 4.04, and -1.17 to 3.78, and PE of 82.21, 78.50, 68.74, and 74.58%, respectively. Polar plot analyses revealed angular bias values of -10.37º, -15.01º, -18.68º, and -12.62º, with radial LoA of 89.79º, 85.86º, 83.38º, and 87.82º, respectively. The four-quadrant plot concordance rates were 70.77, 67.35, 65.90, and 69.79%. These analyses showed poor agreement, weak concordance, and low trending ability of bioimpedance cardiometry to UPC analysis. Conclusions: Bioimpedance and UPC analysis for CI measurements were not interchangeable in patients undergoing kidney transplant surgery. Cardiac index monitoring using bioimpedance cardiometry during kidney transplantation should be interpreted cautiously because it showed poor reliability due to low accuracy, precision, and trending ability for CI measurement.

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Intraoperative Hypotension Increased Risk in the Oncological Patient

Cited by 6 publications

References 46 publications

Individualized Perioperative Hemodynamic Management Using Hypotension Prediction Index Software and the Dynamics of Troponin and NTproBNP Concentration Changes in Patients Undergoing Oncological Abdominal Surgery

Individualized Perioperative Hemodynamic Management Using Hypotension Prediction Index Software and the Dynamics of Troponin and NTproBNP Concentration Changes in Patients Undergoing Oncological Abdominal Surgery

Dexmedetomidine versus remifentanil in nasal surgery: a systematic review and meta-analysis

Comparison of Bioimpedance Versus Pulse Contour Analysis for Intraoperative Cardiac Index Monitoring in Patients Undergoing Kidney Transplantation

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