The incidence of hypotension during general anesthesia: a single-center study at a university hospital

Nobuyuki Katori; Kentaro Yamakawa; Kotaro Kida; Yoshihiro Kimura; Shoko Fujioka; Tsunehisa Tsubokawa

doi:10.1186/s40981-023-00617-9

The incidence of hypotension during general anesthesia: a single-center study at a university hospital

JA Clin Rep. 2023 May 13;9(1):23. doi: 10.1186/s40981-023-00617-9.

Authors

Nobuyuki Katori¹, Kentaro Yamakawa¹, Kotaro Kida¹, Yoshihiro Kimura¹, Shoko Fujioka¹, Tsunehisa Tsubokawa²

Affiliations

¹ Department of Anesthesiology, The Jikei University School of Medicine, 2-25-8 Nishishinbashi, Minato-Ku, Tokyo, 105-8461, Japan.
² Department of Anesthesiology, The Jikei University School of Medicine, 2-25-8 Nishishinbashi, Minato-Ku, Tokyo, 105-8461, Japan. tsunetann@gmail.com.

Abstract

Background: Although intraoperative hypotension (IOH) has been emerging as a serious concern during general anesthesia, the incidence of IOH has not been demonstrated clearly in the Japanese population.

Methods: This single-center retrospective study investigated the incidence and the characteristics of IOH in non-cardiac surgery at a university hospital. IOH was defined as at least one fall of MAP during general anesthesia, which was categorized into the following groups: mild (65 to < 75 mmHg), moderate (55 to < 65 mmHg), severe (45 to < 55 mmHg), and very severe (< 45 mmHg). The incidence of IOH was calculated as a percentage of the number of events to the total anesthesia cases. Logistic regression analysis was performed to examine factors affecting IOH.

Results: Eleven thousand two hundred ten cases out of 13,226 adult patients were included in the analysis. We found moderate to very severe hypotension occurred in 86.3% of the patients for at least 1 to 5 min, and 48.5% experienced severe or very severe hypotension. The results of the logistic regression analysis indicated female gender, vascular surgery, American Society of Anesthesiologists physical status classification (ASA-PS) 4 or 5 in emergency surgery, and the combination with the epidural block (EDB) were significant factors of IOH.

Conclusions: IOH during general anesthesia was very frequent in the Japanese population. Female gender, vascular surgery, ASA-PA 4 or 5 in emergency surgery, and the combination with EDB were independent risk factors associated with IOH. However, the association with patient outcomes were not elucidated.

Keywords: Emergency surgery; Gender; General anesthesia; Intraoperative hypotension; Mean arterial blood pressure; Vascular surgery.