Hypotension, Intraoperative Hypotension, Post Anesthesia Recovery, Post-induction Hypotension
Conditions
Keywords
Complication, Intraoperative Hypotension, PACU outcomes, PACU recovery, Hypotension
Brief summary
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.
Detailed description
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.
Interventions
OTHERHemodynamic observation of the patients.
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.
Sponsors
Acibadem University
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to 85 Years
Inclusion criteria
* 18 years and older * Underwent elective surgery * Received general anesthesia * Planned overnight stay in the hospital after surgery
Exclusion criteria
* Under 18 years of age * Cardiac surgery * Transplant surgery * Preoperatively receiving vasoactive drugs * Patients with mechanical circulatory support * Pediatric surgery * Patients from ICU * Patients with scheduled postoperative ICU admissions
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Effect of IOH types on PACU recovery (Duration) | From the preoperative first monitorization of the patient in the operating room until until discharege from the PACU (0-720 minutes). | 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. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| PACU recovery | Postoperatively from the patient's arrival to the PACU until discharge (0-240 minutes). | Compare the effect of intraoperative hypotension types on PACU recovery to the effect of other factors influencing PACU recovery. |
Other
| Measure | Time frame | Description |
|---|---|---|
| Intraoperative hypotension | From the preoperative first monitorization of the patient in the operating room until extubation and transfer to the PACU (0-480 minutes). | Decrease in mean blood pressure of 30% from baseline for a minimum of 5 minutes, including induction and maintenance of anesthesia. |
| pIOH | From the preoperative first monitorization of the patient in the operating room to the 20th minute after anesthesia induction. | Decrease in mean blood pressure of 30% from baseline during the first 20 min after anesthesia induction. |
| mIOH | From the 20th minute after anesthesia induction until extubation and transfer to the PACU (between 20- 480 minutes). | Decrease of blood pressure 20th min after induction, with or without pIOH. |
| PACU complications: desaturation | Postoperatively from the patient's arrival to the PACU until discharge (0-240 minutes). | Postoperative SpO2\<%90 |
| Effect of IOH types on PACU duration | Postoperatively from the patient's arrival to the PACU until discharge (0-240 minutes). | Different IOH types may have a different impact on the PACU duration. |
| PACU complications: Bradycardia | Postoperatively from the patient's arrival to the PACU until discharge (0-240 minutes). | Postoperative heart rate \< 40 min |
| PACU complications: Tachycardia | Postoperatively from the patient's arrival to the PACU until discharge (0-240 minutes). | Postoperative heart rate \>100 min \>100 min-1 Heart rate \>100 min-1 |
| PACU complications: Gastrointestinal complications | Postoperatively from the patient's arrival to the PACU until discharge (0-240 minutes). | Include nausea and vomiting |
| Unplanned ICU admission | From the preoperative first monitorization of the patient in the operating room until until discharege from the PACU (0-720 minutes). | When ICU bed reservation is not considered in the preoperative period. |
| PACU complications: Arrhythmia | Postoperatively from the patient's arrival to the PACU until discharge (0-240 minutes). | Irregular heartbeat |
| Effect of IOH types on PACU complications | Postoperatively from the patient's arrival to the PACU until discharge (0-240 minutes). | Different IOH types have a different impact on the PACU's complication rate. |
Countries
Turkey (Türkiye)
Outcome results
None listed