Postintubation Hypotension in General Anesthesia

Green, Robert S.; Butler, Michael B.

doi:10.1177/0885066615597198

Cited by 45 publications

(38 citation statements)

References 52 publications

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“…Intra‐operative hypotension has been associated with postoperative acute kidney injury and death in other cohorts . Our results extend previous work by showing that depth and duration of hypotension, both before and after incision, were significantly associated with acute kidney injury, which is consistent with limited data from vascular surgery and emergency airway management .…”

Section: Discussionsupporting

confidence: 90%

The association of hypotension during non‐cardiac surgery, before and after skin incision, with postoperative acute kidney injury: a retrospective cohort analysis

et al. 2018

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Intra-operative hypotension is associated with acute postoperative kidney injury. It is unclear how much hypotension occurs before skin incision compared with after, or whether hypotension in these two periods is similarly associated with postoperative kidney injury. We analysed the association of mean arterial pressure < 65 mmHg with postoperative kidney injury in 42,825 patients who were anaesthetised for elective non-cardiac surgery. Intra-operative hypotension occurred in 30,423 (71%) patients: 22,569 (53%) patients before skin incision; and 24,102 (56%) patients after incision. Anaesthetised patients who were hypotensive had mean arterial pressures < 65 mmHg for a median (IQR [range]) of 5.5 (0.0-14.7 [0.0-60.0]) min.h before skin incision, compared with 1.7 [0.3-5.1 [0.0-57.5]) min.h after incision: a median (IQR [range]) of 36% (0%-84% [0%-100%]) of hypotensive readings were before incision. We diagnosed postoperative kidney injury in 2328 (5%) patients. The odds ratio (95%CI) for acute kidney injury was 1.05 (1.02-1.07) for each doubling of the duration of hypotension, p < 0.001. Postoperative kidney injury was associated with the product of hypotension duration and severity, that is, area under the curve, before skin incision and after, odds ratio (95%CI): 1.02 (1.01-1.04), p = 0.004; and 1.02 (1.00-1.04), p = 0.016, respectively. A substantial fraction of all hypotension happened before surgical incision and was thus completely due to anaesthetic management. We recommend that anaesthetists should avoid mean arterial pressure < 65 mmHg during surgery, especially after induction, assuming that its association with postoperative kidney injury is, at least in part, causal.

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Section: Discussionsupporting

confidence: 90%

The association of hypotension during non‐cardiac surgery, before and after skin incision, with postoperative acute kidney injury: a retrospective cohort analysis

et al. 2018

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“…We found that diuretic use increases risk of PIH. Sedation and the physiologic effects of positive pressure ventilation commonly results in blood pressure reduction surrounding ETI [9]. Therefore, hypovolemia due to diuresis would plausibly exacerbate blood pressure decreases.…”

Section: Clinical Utility Of Hyps and (S) Hypsmentioning

confidence: 99%

“…decreased systemic vascular resistance). However, this risk is not universally recognized and there is substantial variance in best practices associated with safer ETI processes in the ICU [6,9,[10][11][12][13][14][15][16][17]. Further, despite the above cited associations, there is no currently available formal method that predicts the onset of hypotension when an airway is established in the ICU.…”

Section: Introductionmentioning

confidence: 99%

Risk factors for and prediction of post-intubation hypotension in critically ill adults: A multicenter prospective cohort study

et al. 2020

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“…For example, peri-intubation hypotension has been associated with both increased length of stay and mortality [1][2][3]. Furthermore, this association has been identified not only in the critically ill but also in elective surgical patients [4,5]. Several studies indicate that the frequency with which peri-intubation hypotension occurs is fairly high, with one report indicating an incidence of greater than 80% [1,2,5,6].…”

Section: Introductionmentioning

confidence: 99%

“…Furthermore, this association has been identified not only in the critically ill but also in elective surgical patients [4,5]. Several studies indicate that the frequency with which peri-intubation hypotension occurs is fairly high, with one report indicating an incidence of greater than 80% [1,2,5,6]. However, the data presented on the frequency is dependent on definitions currently used in the literature for which no standard consensus exists.…”

Section: Introductionmentioning

confidence: 99%

Effect of Ketamine/Propofol Admixture on Peri-Induction Hemodynamics: A Systematic Review and Meta-Analysis

Smischney

Seisa

Morrow

et al. 2020

Anesthesiology Research and Practice

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To evaluate the effectiveness of an admixture of ketamine and propofol on peri-induction hemodynamics during airway manipulation, we searched electronic databases of randomized controlled trials from January 1, 2000, to October 17, 2018. Trial screening, selection, and data extraction were done independently by two reviewers with outcomes pooled across included trials using the random-effects model. We included 10 randomized trials (722 patients, mean age of 53.99 years, 39.96% female). American Society of Anesthesiologists physical status was reported in 9 trials with classes I and II representing the majority. Ketamine/propofol admixture was associated with a nonsignificant increase in heart rate (weighted mean difference, 3.36 beats per minute (95% CI, −0.88, 7.60), I2 = 88.6%), a statistically significant increase in systolic blood pressure (weighted mean difference, 9.67 mmHg (95% CI, 1.48, 17.86), I2 = 87.2%), a nonsignificant increase in diastolic blood pressure (weighted mean difference, 2.18 mmHg (95% CI, −2.82, 7.19), I2 = 73.1%), and a nonsignificant increase in mean arterial pressure (weighted mean difference, 3.28 mmHg (95% CI, −0.94, 7.49), I2 = 69.9%) compared to other agents. The risk of bias was high and the certainty of evidence was low. In conclusion, among patients undergoing airway manipulation and needing sedation, the use of a ketamine/propofol admixture may be associated with better hemodynamics compared to nonketamine/propofol sedation. This trial is registered with CRD42019125725.

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Postintubation Hypotension in General Anesthesia

Abstract: Development of PIH occurs in 60% of patients undergoing intubation for vascular surgery and was associated with adverse outcomes including extended ICU LOS and postop ventilation requirement.

Cited by 45 publications

References 52 publications

The association of hypotension during non‐cardiac surgery, before and after skin incision, with postoperative acute kidney injury: a retrospective cohort analysis

The association of hypotension during non‐cardiac surgery, before and after skin incision, with postoperative acute kidney injury: a retrospective cohort analysis

Risk factors for and prediction of post-intubation hypotension in critically ill adults: A multicenter prospective cohort study

Effect of Ketamine/Propofol Admixture on Peri-Induction Hemodynamics: A Systematic Review and Meta-Analysis

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