Hojo T, Kimura Y, Shibuya M, Fujisawa T. Predictors of hypotension during anesthesia induction in patients with hypertension on medication: a retrospective observational study.
BMC Anesthesiol 2022;
22:343. [PMID:
36368916 PMCID:
PMC9650866 DOI:
10.1186/s12871-022-01899-9]
[Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 11/07/2022] [Indexed: 11/13/2022] Open
Abstract
Background
Hypotension during anesthesia induction is a common event, and occurs more frequently in patients with hypertension than in healthy individuals. Intraoperative hypotension in non-cardiac surgery is reportedly associated with various postoperative complications. However, the predictors of hypotension during anesthesia induction in patients with hypertension have not yet been ascertained. Therefore, we aimed to determine the predictors of hypotension during anesthesia induction in patients with hypertension on medication focusing on the half-life of the medication used.
Methods
In this retrospective observational study, we enrolled patients with hypertension on medication who underwent general anesthesia for oral and maxillofacial surgery between January 1, 2013, and December 31, 2019. Multivariable logistic regression analysis was conducted to test for associations between clinical factors and hypotension during anesthesia induction in patients with hypertension on medication.
Results
A total of 395 patients were included in this study. The risk factors for hypotension during anesthesia induction in patients with hypertension on medication were pre-induction mean arterial blood pressure (adjusted unit odds ratio, 0.96 [95% confidence interval, 0.94 to 0.98]), female sex (adjusted odds ratio [aOR], 1.63 [1.03 to 2.57]), regular use of angiotensin receptor blockers (ARBs)/angiotensin-converting enzyme inhibitors (ACE-Is) with a long half-life (vs. no regular use of ARBs/ACE-Is aOR, 4.02 [1.77 to 9.12]; vs. regular use of ARBs/ACE-Is with a short-to-middle half-life aOR, 3.17 [1.46 to 6.85]), and regular use of beta blockers (aOR, 2.45 [1.19 to 5.04]). Regular use of calcium channel blockers (aOR, 0.44 [0.25 to 0.77]) was a suppressive factor for hypotension during anesthesia induction in patients with hypertension.
Conclusions
In patients with hypertension on medication, regular use of ARBs/ACE-Is with a long half-life, regular use of beta blockers, low pre-induction mean arterial blood pressure, and female sex were risk factors for hypotension during anesthesia induction. Notably, regular use of ARBs/ACE-Is with a long half-life was a high-risk factor for hypotension during anesthesia induction in patients with hypertension on medication even after a 24-h preoperative withdrawal period.
Supplementary Information
The online version contains supplementary material available at 10.1186/s12871-022-01899-9.
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