Preoperative Hypercapnia as a Predictor of Hypotension During Anesthetic Induction in Lung Transplant Recipients
Objective To determine the incidence and predisposing factors of hypotension during anesthetic induction in lung transplant recipients. Design Retrospective study. Setting University hospital. Participants Patients who underwent lung transplantation between 2008 and 2013 (n = 68). Interventions None...
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| Veröffentlicht in: | Journal of cardiothoracic and vascular anesthesia 2015-08, Vol.29 (4), p.967-971 |
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| creator | Mizota, Toshiyuki, MD Matsukawa, Shino, MD Fukagawa, Hiroshi, MD Daijo, Hiroki, MD, PhD Tanaka, Tomoharu, MD, PhD Chen, Fengshi, MD, PhD Date, Hiroshi, MD, PhD Fukuda, Kazuhiko, MD, PhD |
| description | Objective To determine the incidence and predisposing factors of hypotension during anesthetic induction in lung transplant recipients. Design Retrospective study. Setting University hospital. Participants Patients who underwent lung transplantation between 2008 and 2013 (n = 68). Interventions None. Measurements and Main Results The authors analyzed the mean arterial pressure (MAP) from administration of anesthetic drugs to 10 minutes after endotracheal intubation (ie, the anesthetic induction) among participants who underwent lung transplantation. Patients were considered to have clinically significant hypotension (CSH) when the following criteria were fulfilled: An MAP decrease of>40% from baseline and MAP of |
| doi_str_mv | 10.1053/j.jvca.2014.10.027 |
| format | Article |
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Design Retrospective study. Setting University hospital. Participants Patients who underwent lung transplantation between 2008 and 2013 (n = 68). Interventions None. Measurements and Main Results The authors analyzed the mean arterial pressure (MAP) from administration of anesthetic drugs to 10 minutes after endotracheal intubation (ie, the anesthetic induction) among participants who underwent lung transplantation. Patients were considered to have clinically significant hypotension (CSH) when the following criteria were fulfilled: An MAP decrease of>40% from baseline and MAP of<60 mmHg. Overall, 41.2% of patients experienced CSH during the induction of anesthesia. The preoperative partial pressure of carbon dioxide (PaCO2 ) was significantly higher in patients who experienced CSH during anesthetic induction than in those who did not (p = 0.005). Preoperative PaCO2 predicted the development of CSH during anesthetic induction (area under the curve = 0.702; p = 0.002), with an optimal cut-off point of 55 mmHg determined by maximizing the Youden index. The incidences of CSH during anesthetic induction for patients with (PaCO2 ≥55) and without (PaCO2 <55) preoperative hypercapnia were 75.0% (95% confidence interval [CI] [53.8-89.2]) and 30.8% (95% CI 26.4-37.3), respectively. After adjustment for known predicting factors, the odds ratio for the relationship between preoperative hypercapnia and CSH during anesthetic induction was 12.54 (95% CI 3.10–66.66). Conclusions Hypotension during anesthetic induction is common in lung transplant recipients, and is independently predicted by preoperative hypercapnia.</description><identifier>ISSN: 1053-0770</identifier><identifier>EISSN: 1532-8422</identifier><identifier>DOI: 10.1053/j.jvca.2014.10.027</identifier><identifier>PMID: 25649696</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adolescent ; Adult ; Anesthesia & Perioperative Care ; Anesthesia - adverse effects ; Anesthesia - trends ; anesthetic induction ; Child ; Critical Care ; Female ; Humans ; hypercapnia ; Hypercapnia - diagnosis ; Hypercapnia - epidemiology ; hypotension ; Hypotension - diagnosis ; Hypotension - epidemiology ; lung transplantation ; Lung Transplantation - adverse effects ; Lung Transplantation - trends ; Male ; Middle Aged ; Predictive Value of Tests ; Preoperative Care - methods ; Preoperative Care - trends ; Retrospective Studies ; Transplant Recipients ; Young Adult</subject><ispartof>Journal of cardiothoracic and vascular anesthesia, 2015-08, Vol.29 (4), p.967-971</ispartof><rights>Elsevier Inc.</rights><rights>2015 Elsevier Inc.</rights><rights>Copyright © 2015 Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c569t-eed165c7a5e11ad2b7c3181154e0dc363794d5668ae5b35ca615aeac7e9ecc8c3</citedby><cites>FETCH-LOGICAL-c569t-eed165c7a5e11ad2b7c3181154e0dc363794d5668ae5b35ca615aeac7e9ecc8c3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1053/j.jvca.2014.10.027$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3548,27923,27924,45994</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/25649696$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Mizota, Toshiyuki, MD</creatorcontrib><creatorcontrib>Matsukawa, Shino, MD</creatorcontrib><creatorcontrib>Fukagawa, Hiroshi, MD</creatorcontrib><creatorcontrib>Daijo, Hiroki, MD, PhD</creatorcontrib><creatorcontrib>Tanaka, Tomoharu, MD, PhD</creatorcontrib><creatorcontrib>Chen, Fengshi, MD, PhD</creatorcontrib><creatorcontrib>Date, Hiroshi, MD, PhD</creatorcontrib><creatorcontrib>Fukuda, Kazuhiko, MD, PhD</creatorcontrib><title>Preoperative Hypercapnia as a Predictor of Hypotension During Anesthetic Induction in Lung Transplant Recipients</title><title>Journal of cardiothoracic and vascular anesthesia</title><addtitle>J Cardiothorac Vasc Anesth</addtitle><description>Objective To determine the incidence and predisposing factors of hypotension during anesthetic induction in lung transplant recipients. Design Retrospective study. Setting University hospital. Participants Patients who underwent lung transplantation between 2008 and 2013 (n = 68). Interventions None. Measurements and Main Results The authors analyzed the mean arterial pressure (MAP) from administration of anesthetic drugs to 10 minutes after endotracheal intubation (ie, the anesthetic induction) among participants who underwent lung transplantation. Patients were considered to have clinically significant hypotension (CSH) when the following criteria were fulfilled: An MAP decrease of>40% from baseline and MAP of<60 mmHg. Overall, 41.2% of patients experienced CSH during the induction of anesthesia. The preoperative partial pressure of carbon dioxide (PaCO2 ) was significantly higher in patients who experienced CSH during anesthetic induction than in those who did not (p = 0.005). Preoperative PaCO2 predicted the development of CSH during anesthetic induction (area under the curve = 0.702; p = 0.002), with an optimal cut-off point of 55 mmHg determined by maximizing the Youden index. The incidences of CSH during anesthetic induction for patients with (PaCO2 ≥55) and without (PaCO2 <55) preoperative hypercapnia were 75.0% (95% confidence interval [CI] [53.8-89.2]) and 30.8% (95% CI 26.4-37.3), respectively. After adjustment for known predicting factors, the odds ratio for the relationship between preoperative hypercapnia and CSH during anesthetic induction was 12.54 (95% CI 3.10–66.66). Conclusions Hypotension during anesthetic induction is common in lung transplant recipients, and is independently predicted by preoperative hypercapnia.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Anesthesia & Perioperative Care</subject><subject>Anesthesia - adverse effects</subject><subject>Anesthesia - trends</subject><subject>anesthetic induction</subject><subject>Child</subject><subject>Critical Care</subject><subject>Female</subject><subject>Humans</subject><subject>hypercapnia</subject><subject>Hypercapnia - diagnosis</subject><subject>Hypercapnia - epidemiology</subject><subject>hypotension</subject><subject>Hypotension - diagnosis</subject><subject>Hypotension - epidemiology</subject><subject>lung transplantation</subject><subject>Lung Transplantation - adverse effects</subject><subject>Lung Transplantation - trends</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Predictive Value of Tests</subject><subject>Preoperative Care - methods</subject><subject>Preoperative Care - trends</subject><subject>Retrospective Studies</subject><subject>Transplant Recipients</subject><subject>Young Adult</subject><issn>1053-0770</issn><issn>1532-8422</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kU9v1DAQxSMEon_oF-CAfOSSxXbiOJEQUtVSWmklqtKeLe9kFhyydrCdlfbbM9EWDhw4eTTvzdPMz0XxVvCV4Kr6MKyGPdiV5KKmxopL_aI4FaqSZVtL-ZJqcpVca35SnKU0cC6EUvp1cSJVU3dN15wW033EMGG02e2R3R6oBDt5Z5lNzDJSewc5RBa2ixoy-uSCZ9dzdP47u_SY8g_MDtid72fIi-Y8W88kPkbr0zRan9kDgpsc-pzeFK-2dkx48fyeF083nx-vbsv11y93V5frElTT5RKxF40CbRUKYXu50VCJlvavkfdQNZXu6l41TWtRbSoFthHKogWNHQK0UJ0X74-5Uwy_ZtrS7FwCHGkdDHMyQnNFQOpWk1UerRBDShG3ZopuZ-PBCG4WhmYwC2mzkF56RJqG3j3nz5sd9n9H_qAlw8ejAenKvcNoEhABIKARIZs-uP_nf_pnHEbnHdjxJx4wDWGOnvgZYZI03HxbcpavFjWnSunqN4-Tpk4</recordid><startdate>20150801</startdate><enddate>20150801</enddate><creator>Mizota, Toshiyuki, MD</creator><creator>Matsukawa, Shino, MD</creator><creator>Fukagawa, Hiroshi, MD</creator><creator>Daijo, Hiroki, MD, PhD</creator><creator>Tanaka, Tomoharu, MD, PhD</creator><creator>Chen, Fengshi, MD, PhD</creator><creator>Date, Hiroshi, MD, PhD</creator><creator>Fukuda, Kazuhiko, MD, PhD</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20150801</creationdate><title>Preoperative Hypercapnia as a Predictor of Hypotension During Anesthetic Induction in Lung Transplant Recipients</title><author>Mizota, Toshiyuki, MD ; Matsukawa, Shino, MD ; Fukagawa, Hiroshi, MD ; Daijo, Hiroki, MD, PhD ; Tanaka, Tomoharu, MD, PhD ; Chen, Fengshi, MD, PhD ; Date, Hiroshi, MD, PhD ; Fukuda, Kazuhiko, MD, PhD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c569t-eed165c7a5e11ad2b7c3181154e0dc363794d5668ae5b35ca615aeac7e9ecc8c3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Anesthesia & Perioperative Care</topic><topic>Anesthesia - adverse effects</topic><topic>Anesthesia - trends</topic><topic>anesthetic induction</topic><topic>Child</topic><topic>Critical Care</topic><topic>Female</topic><topic>Humans</topic><topic>hypercapnia</topic><topic>Hypercapnia - diagnosis</topic><topic>Hypercapnia - epidemiology</topic><topic>hypotension</topic><topic>Hypotension - diagnosis</topic><topic>Hypotension - epidemiology</topic><topic>lung transplantation</topic><topic>Lung Transplantation - adverse effects</topic><topic>Lung Transplantation - trends</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Predictive Value of Tests</topic><topic>Preoperative Care - methods</topic><topic>Preoperative Care - trends</topic><topic>Retrospective Studies</topic><topic>Transplant Recipients</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Mizota, Toshiyuki, MD</creatorcontrib><creatorcontrib>Matsukawa, Shino, MD</creatorcontrib><creatorcontrib>Fukagawa, Hiroshi, MD</creatorcontrib><creatorcontrib>Daijo, Hiroki, MD, PhD</creatorcontrib><creatorcontrib>Tanaka, Tomoharu, MD, PhD</creatorcontrib><creatorcontrib>Chen, Fengshi, MD, PhD</creatorcontrib><creatorcontrib>Date, Hiroshi, MD, PhD</creatorcontrib><creatorcontrib>Fukuda, Kazuhiko, MD, PhD</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of cardiothoracic and vascular anesthesia</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Mizota, Toshiyuki, MD</au><au>Matsukawa, Shino, MD</au><au>Fukagawa, Hiroshi, MD</au><au>Daijo, Hiroki, MD, PhD</au><au>Tanaka, Tomoharu, MD, PhD</au><au>Chen, Fengshi, MD, PhD</au><au>Date, Hiroshi, MD, PhD</au><au>Fukuda, Kazuhiko, MD, PhD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Preoperative Hypercapnia as a Predictor of Hypotension During Anesthetic Induction in Lung Transplant Recipients</atitle><jtitle>Journal of cardiothoracic and vascular anesthesia</jtitle><addtitle>J Cardiothorac Vasc Anesth</addtitle><date>2015-08-01</date><risdate>2015</risdate><volume>29</volume><issue>4</issue><spage>967</spage><epage>971</epage><pages>967-971</pages><issn>1053-0770</issn><eissn>1532-8422</eissn><abstract>Objective To determine the incidence and predisposing factors of hypotension during anesthetic induction in lung transplant recipients. Design Retrospective study. Setting University hospital. Participants Patients who underwent lung transplantation between 2008 and 2013 (n = 68). Interventions None. Measurements and Main Results The authors analyzed the mean arterial pressure (MAP) from administration of anesthetic drugs to 10 minutes after endotracheal intubation (ie, the anesthetic induction) among participants who underwent lung transplantation. Patients were considered to have clinically significant hypotension (CSH) when the following criteria were fulfilled: An MAP decrease of>40% from baseline and MAP of<60 mmHg. Overall, 41.2% of patients experienced CSH during the induction of anesthesia. The preoperative partial pressure of carbon dioxide (PaCO2 ) was significantly higher in patients who experienced CSH during anesthetic induction than in those who did not (p = 0.005). Preoperative PaCO2 predicted the development of CSH during anesthetic induction (area under the curve = 0.702; p = 0.002), with an optimal cut-off point of 55 mmHg determined by maximizing the Youden index. The incidences of CSH during anesthetic induction for patients with (PaCO2 ≥55) and without (PaCO2 <55) preoperative hypercapnia were 75.0% (95% confidence interval [CI] [53.8-89.2]) and 30.8% (95% CI 26.4-37.3), respectively. After adjustment for known predicting factors, the odds ratio for the relationship between preoperative hypercapnia and CSH during anesthetic induction was 12.54 (95% CI 3.10–66.66). Conclusions Hypotension during anesthetic induction is common in lung transplant recipients, and is independently predicted by preoperative hypercapnia.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>25649696</pmid><doi>10.1053/j.jvca.2014.10.027</doi><tpages>5</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Adolescent Adult Anesthesia & Perioperative Care Anesthesia - adverse effects Anesthesia - trends anesthetic induction Child Critical Care Female Humans hypercapnia Hypercapnia - diagnosis Hypercapnia - epidemiology hypotension Hypotension - diagnosis Hypotension - epidemiology lung transplantation Lung Transplantation - adverse effects Lung Transplantation - trends Male Middle Aged Predictive Value of Tests Preoperative Care - methods Preoperative Care - trends Retrospective Studies Transplant Recipients Young Adult |
| title | Preoperative Hypercapnia as a Predictor of Hypotension During Anesthetic Induction in Lung Transplant Recipients |
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