Risks of adverse events in patients with orthostatic intolerance undergoing surgery with general anesthesia

Ruzieh, Mohammed; Sacks, Cody D; Grewal, Simran; Aboujamous, Nader M.; Grubb, Blair P.; Fedorowski, Artur

doi:10.1007/s10286-020-00697-y

Cited by 1 publication

(3 citation statements)

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“…Meta‐analysis data suggest a relationship between OH and all‐cause mortality and cardiovascular pathology including coronary artery disease, heart failure and stroke 11 . Expected “cardiac history” and ECG‐culprits were not identified in our patients, but post‐operative cardiac events in patients with OH have been reported 7 . Many of these comorbidities occur commonly in older adults.…”

Section: Discussionmentioning

confidence: 77%

“…Pre‐operative incidence of OH/OI in patients was either not reported 4,5 or not found 6 . Interestingly, one retrospective study included 131 patients (mean age 79‐years) with pre‐operative classical‐OH confirmed by BP measurement and demonstrated post‐operative major cardiac events in 4.7% with a 6.1% 30‐day mortality rate, although this was comparable to the predicted incidence in non‐OH patients 7 …”

Section: Introductionmentioning

confidence: 95%

“…Classical OH is well‐defined as a fall in blood pressure (BP) within approximately 3‐minutes of standing 1 and often presents with co‐existing symptoms of orthostatic intolerance (OI) including dizziness on standing. Despite a relatively high community prevalence of OH (6.9%), OI (39.0%) and faints (4.6%) in adults aged over 50 years, 2 and an increasingly recognised relationship with frailty due to shared underlying comorbidities and reduced physiological reserve, 3 few studies have considered OH/OI presenting during the perioperative period 4‐7 . The largest published cohort found a high proportion of patients aged between 58 and 79 years with OH/OI detected post‐operatively (38.6%, 191/495) 4 .…”

Section: Introductionmentioning

confidence: 99%

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The Effect of Orthostatic Hypotension Detected Pre‐Operatively on Post‐Operative Outcome

Hogan

Luck

Woods

et al. 2020

J American Geriatrics Society

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BACKGROUND Exacerbation of or new onset orthostatic hypotension in perioperative patients can occur. There is complex underlying pathophysiology with further derailment likely caused by acute cardiovascular changes associated with surgery. The implications for post‐operative recovery are unclear, particularly in frail and older patients. We retrospectively explored patient notes for evidence of post‐operative orthostatic intolerance in relation to pre‐operative orthostatic hypotension. METHODS Supine and 1‐minute and 3‐minute standing blood pressure measures obtained from adult patients before mainly general, orthopedic or uro/gynecology surgery were compared to post‐operative outcome, specifically, evidence in patient notes about falls, feeling dizzy/unsteady and/or fearful to stand. Orthostatic hypotension was defined as a 20 mmHg or more and/or 10 mmHg or more fall in systolic and diastolic blood pressure, respectively, within ~3 minutes of standing after lying supine for an electrocardiogram. RESULTS Whilst all patients included had a 1‐minute standing blood pressure assessment (N = 170), 3‐minute assessment was performed less commonly (N = 113). Nevertheless, one‐quarter (23.5%; N = 40) of 170 patients had pre‐operative orthostatic hypotension. This was not clearly explained by cardiac or neurological disease or by common medications, but did occur more frequently in older patients and in those aged 65 years or more with higher clinical frailty scale scores. The COVID‐19 pandemic reduced the number of patients progressing to surgery within the planned study timescale (N = 143/170; 84.1%). Nevertheless, patients with orthostatic hypotension stayed longer in hospital post‐operatively and were more likely to have an episode of fall, unsteadiness and/or dizziness documented (un‐prompted) in their notes. CONCLUSIONS These data provide further impetus for research into modifiable perioperative risk factors associated with orthostatic hypotension. These risks are not confined to those with a pre‐existing dysautonomia diagnosis.

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Section: Discussionmentioning

confidence: 77%