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The underlying causative mechanism that leads to intraoperative hypotension (IOH) may vary depending on the stage of anesthesia and surgery, which determines different IOH types. Naturally, the incidence and severity of IOH types will differ, as will the incidence and severity of postoperative complications.
Background The underlying causative mechanism that leads to intraoperative hypotension (IOH) may vary depending on the stage of anesthesia and surgery, which determines different IOH types. Naturally, the incidence and severity of IOH types will differ, as will the incidence and severity of postoperative complications.
Methods The investigators conducted a data-based observational study that included 4776 patients. Post-induction hypotension (pIOH) is defined as a decrease during the first 20 min after anesthesia induction and maintenance intraoperative hypotension (mIOH) when there is a decrease of blood pressure 20th min after induction, with or without pIOH.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Post-induction hypotension | Post-induction hypotension (pIOH) is a decrease during the first 20 min after anesthesia induction |
| |
| Maintenance intraoperative hypotension | maintenance intraoperative hypotension (mIOH) when there is a decrease of blood pressure 20th min after induction, with or without pIOH |
| |
| Normotensive patients | Patients with normotension during surgery. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Hemodynamic observation of the patients. | Other | For the purposes of this study, we defined intraoperative hypotension as a decrease in mean blood pressure of 30% from baseline for a minimum of 5 minutes, including induction and maintenance of anesthesia. The measuring blood pressure method (noninvasive or invasive) depended on the surgical intervention's invasiveness and the patient's cardiac performance. As soon as the patients entered the PACU, the responsible nurses started the standard monitoring. Anesthesiologists constantly oversee all actions based on the patient's condition. Clinical observation for respiratory and gastrointestinal problems and all disorders were monitored. When in room air SO2 was <94, we started oxygen treatment with a 4 liter/minute nasal cannula, and in cases of nausea antiemetic was administered. The Modified Aldrete Score was used to discharge the patent. |
| Measure | Description | Time Frame |
|---|---|---|
| Effect of IOH types on PACU recovery (Duration) | The underlying causative mechanism that leads to IOH may vary depending on the stage of anesthesia and surgery, which determines different IOH types; therefore recovery after them will differ. care unit (PACU) recovery, especially duration and complications in the PACU. | From the preoperative first monitorization of the patient in the operating room until until discharege from the PACU (0-720 minutes). |
| Measure | Description | Time Frame |
|---|---|---|
| PACU recovery | Compare the effect of intraoperative hypotension types on PACU recovery to the effect of other factors influencing PACU recovery. | Postoperatively from the patient's arrival to the PACU until discharge (0-240 minutes). |
| Measure | Description | Time Frame |
|---|---|---|
| Effect of IOH types on PACU duration | Different IOH types may have a different impact on the PACU duration. | Postoperatively from the patient's arrival to the PACU until discharge (0-240 minutes). |
| Effect of IOH types on PACU complications |
Inclusion Criteria:
Exclusion Criteria:
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We conducted a data-based observational study. Only routinely documented patient data was considered in the recent study. All patients' preoperative and postoperative recovery room data is recorded in a virtual environment. Data describing consecutive patients were collected until the patient was discharged to a ward. Data included demographics, comorbidities, perioperative hemodynamic parameters, duration of PACU, complications in PACU, and non-planned intensive care admission.
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| Name | Affiliation | Role |
|---|---|---|
| Lerzan Dogan, MD | Acibadem University | Study Chair |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Acibadem University | Istanbul | 34662 | Turkey (Türkiye) |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 17667564 | Background | Bijker JB, van Klei WA, Kappen TH, van Wolfswinkel L, Moons KG, Kalkman CJ. Incidence of intraoperative hypotension as a function of the chosen definition: literature definitions applied to a retrospective cohort using automated data collection. Anesthesiology. 2007 Aug;107(2):213-20. doi: 10.1097/01.anes.0000270724.40897.8e. | |
| 28974066 |
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Data on patients is available.
1 year
valid reason
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| ID | Term |
|---|---|
| D007022 | Hypotension |
| ID | Term |
|---|---|
| D014652 | Vascular Diseases |
| D002318 | Cardiovascular Diseases |
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Different IOH types have a different impact on the PACU's complication rate.
| Postoperatively from the patient's arrival to the PACU until discharge (0-240 minutes). |
| Intraoperative hypotension | Decrease in mean blood pressure of 30% from baseline for a minimum of 5 minutes, including induction and maintenance of anesthesia. | From the preoperative first monitorization of the patient in the operating room until extubation and transfer to the PACU (0-480 minutes). |
| pIOH | Decrease in mean blood pressure of 30% from baseline during the first 20 min after anesthesia induction. | From the preoperative first monitorization of the patient in the operating room to the 20th minute after anesthesia induction. |
| mIOH | Decrease of blood pressure 20th min after induction, with or without pIOH. | From the 20th minute after anesthesia induction until extubation and transfer to the PACU (between 20- 480 minutes). |
| PACU complications: desaturation | Postoperative SpO2<%90 | Postoperatively from the patient's arrival to the PACU until discharge (0-240 minutes). |
| PACU complications: Arrhythmia | Irregular heartbeat | Postoperatively from the patient's arrival to the PACU until discharge (0-240 minutes). |
| PACU complications: Bradycardia | Postoperative heart rate < 40 min | Postoperatively from the patient's arrival to the PACU until discharge (0-240 minutes). |
| PACU complications: Tachycardia | Postoperative heart rate >100 min >100 min-1 Heart rate >100 min-1 | Postoperatively from the patient's arrival to the PACU until discharge (0-240 minutes). |
| PACU complications: Gastrointestinal complications | Include nausea and vomiting | Postoperatively from the patient's arrival to the PACU until discharge (0-240 minutes). |
| Unplanned ICU admission | When ICU bed reservation is not considered in the preoperative period. | From the preoperative first monitorization of the patient in the operating room until until discharege from the PACU (0-720 minutes). |
| Sudfeld S, Brechnitz S, Wagner JY, Reese PC, Pinnschmidt HO, Reuter DA, Saugel B. Post-induction hypotension and early intraoperative hypotension associated with general anaesthesia. Br J Anaesth. 2017 Jul 1;119(1):57-64. doi: 10.1093/bja/aex127. |
| 33177322 | Background | Gregory A, Stapelfeldt WH, Khanna AK, Smischney NJ, Boero IJ, Chen Q, Stevens M, Shaw AD. Intraoperative Hypotension Is Associated With Adverse Clinical Outcomes After Noncardiac Surgery. Anesth Analg. 2021 Jun 1;132(6):1654-1665. doi: 10.1213/ANE.0000000000005250. |
| 9728843 | Background | Waddle JP, Evers AS, Piccirillo JF. Postanesthesia care unit length of stay: quantifying and assessing dependent factors. Anesth Analg. 1998 Sep;87(3):628-33. doi: 10.1097/00000539-199809000-00026. |
| 34859868 | Background | Chen B, Pang QY, An R, Liu HL. A systematic review of risk factors for postinduction hypotension in surgical patients undergoing general anesthesia. Eur Rev Med Pharmacol Sci. 2021 Nov;25(22):7044-7050. doi: 10.26355/eurrev_202111_27255. |
| 30027443 | Background | Jor O, Maca J, Koutna J, Gemrotova M, Vymazal T, Litschmannova M, Sevcik P, Reimer P, Mikulova V, Trlicova M, Cerny V. Hypotension after induction of general anesthesia: occurrence, risk factors, and therapy. A prospective multicentre observational study. J Anesth. 2018 Oct;32(5):673-680. doi: 10.1007/s00540-018-2532-6. Epub 2018 Jul 19. |
| 37577293 | Derived | Dogan L, Yildirim SA, Sarikaya T, Ulugol H, Gucyetmez B, Toraman F. Different Types of Intraoperative Hypotension and their Association with Post-Anesthesia Care Unit Recovery. Glob Heart. 2023 Aug 11;18(1):44. doi: 10.5334/gh.1257. eCollection 2023. |