Key result
Right heart failure fails to significantly predict post-induction hypotension during general anesthesia in pulmonary hypertension.
Why the study?
Predictors of post-induction hypotension during general anesthesia in patients with varying degrees of pulmonary hypertension were not well defined.
Observational (n=857)
No
In patients with pulmonary hypertension undergoing general anesthesia, no strong predictors for post-induction hypotension were identified, though diabetes and spontaneous ventilation were associated with lower rates.
Answers are grounded in this paper and cite their sources.
Non-significant association does not support right heart failure as a predictor; hypothesis-generating and should not yet change perioperative assessment in pulmonary hypertension.
Purpose The purpose is to identify predictors of post-induction hypotension (PIH) during general anesthesia in a population of patients with varying degrees of pulmonary hypertension (PH). Methods This is a single-center, retrospective, observational study of perioperative data obtained via electronic health records from patients with PH undergoing surgery over a five-year period. Baseline patient characteristics, peri-induction management variables, and pre-induction mean arterial pressure (MAP) were statistically analyzed using Kruskal-Wallis rank sum tests, Pearson's chi-squared tests, and logistic regression analysis to identify risk factors for PIH. We further assessed the relationship between PH and PIH using propensity score matching. Primary outcomes include a percent decrease in post-induction blood pressure as well as a post-induction nadir with a threshold of 55 mm Hg. Results Eight hundred fifty-seven patients in the cohort stratified by severity of PH reveal that advanced age (p < 0.001), higher BMI (P = 0.002), higher American Society of Anesthesiologists (ASA) score (P = 0.001), and renal and cardiac comorbidities (P < 0.001) are associated with PH severity. None of our tested parameters were significantly predictive for PIH in patients with PH. Right heart failure was found to be weakly and non-significantly predictive of PIH in patients with PH (P = 0.052, odds ratio [OR] = 1.116). Diabetes (P = 0.007, OR = 0.919) and maintenance of spontaneous ventilation (P = 0.012, OR = 0.925) were associated with decreased rates of PIH. Conclusion Hypotension after induction of general anesthesia in patients with PH is a serious problem, yet statistically significant risk factors were not identified. History of diabetes and preservation of spontaneous ventilation had a significant but weak effect of decreasing rates of PIH. This pilot study was limited by retrospective design and warrants further analysis with a prospective cohort.
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Bellotti et al. (2022) conducted an observational in Pulmonary hypertension (n=857). Right heart failure vs. Absence of right heart failure was evaluated on Post-induction hypotension (mean arterial pressure < 55 mm Hg within 10 minutes following anesthetic induction) (OR 1.116, 95% CI 0.999-1.247, p=0.052). In patients with pulmonary hypertension undergoing general anesthesia, right heart failure was weakly and non-significantly predictive of post-induction hypotension (OR 1.116).
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