Feasibility of Anesthesiologist-Performed Preoperative Echocardiography for the Prediction of Postinduction Hypotension: A Prospective Observational Study.

IF 1.6 Q2 ANESTHESIOLOGY Anesthesiology Research and Practice Pub Date : 2020-10-20 eCollection Date: 2020-01-01 DOI:10.1155/2020/1375741
Babar Fiza, Neal Duggal, Caitlin E McMillan, Graciela Mentz, Michael D Maile
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引用次数: 4

Abstract

Purpose: To determine if left ventricular or inferior vena cava (IVC) measurements are easier to obtain on point-of-care ultrasound by anesthesiologists in preoperative patients, and to assess the relationship between preoperative cardiac dimensions and hypotension with the induction of general anesthesia.

Methods: This prospective observational study was conducted at a large academic medical center. Sixty-three patients undergoing noncardiac surgeries under general anesthesia were enrolled. Ultrasound examinations were performed by anesthesiologists in the preoperative area. To ensure that hypotension represented both a relative and absolute decrease in blood pressure, both a mean arterial pressure (MAP) < 65 mmHg and a MAP decrease of >30% from preoperative value defined this outcome.

Results: Left ventricular measurements were more likely to be acquired than IVC measurements (97% vs. 79%). Subjects without adequate images to assess IVC collapsibility tended to have a higher body mass index (33.6 ± 5.5 vs. 28.5 ± 4.5, p=0.001). While high left ventricular end-diastolic diameter values were associated with a decreased odds of MAP < 65 mmHg (OR: 0.24, 95% CI: 0.07-0.83, p=0.023) or a MAP decrease of >30% from baseline alone (OR: 0.25, 95% CI: 0.07-0.83, p=0.023), the primary endpoint of both relative and absolute hypotension was not associated with preoperative left ventricular dimensions.

Conclusions: Preoperative cardiac ultrasound may be a more reliable way for anesthesiologists to assess patients' volume status compared to ultrasound of the IVC, particularly for patients with a higher body mass index.

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麻醉医师术前超声心动图预测诱导后低血压的可行性:一项前瞻性观察研究。
目的:探讨麻醉医师对术前患者的左心室或下腔静脉(IVC)测量是否更容易获得,并评估术前心脏尺寸和低血压与全麻诱导的关系。方法:本前瞻性观察研究在一家大型学术医疗中心进行。63例在全身麻醉下接受非心脏手术的患者被纳入研究。术前由麻醉师进行超声检查。为了确保低血压代表血压的相对和绝对下降,平均动脉压(MAP)较术前值的30%定义了这一结果。结果:左心室测量比下腔静脉测量更容易获得(97%对79%)。没有足够图像来评估下腔静脉可折叠性的受试者往往有更高的体重指数(33.6±5.5比28.5±4.5,p=0.001)。虽然高左心室舒张末期内径值与MAP降低的几率(p=0.023)或与基线相比MAP降低>30%相关(or: 0.25, 95% CI: 0.07-0.83, p=0.023),但相对和绝对低血压的主要终点与术前左心室尺寸无关。结论:术前心脏超声可能是麻醉医师评估患者下腔超声容量状态的更可靠的方法,特别是对于体重指数较高的患者。
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CiteScore
3.10
自引率
0.00%
发文量
29
审稿时长
18 weeks
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