Predictors of Post-induction Hypotension for Patients With Pulmonary Hypertension

Adriano Bellotti; Simrat Arora; Chelsea Gustafson; Ian Funk; Craig Grossheusch; Carter Simmers; Quefeng Li; Yutong Liu; Alan Smeltz

doi:10.7759/cureus.31887

Predictors of Post-induction Hypotension for Patients With Pulmonary Hypertension

Cureus. 2022 Nov 25;14(11):e31887. doi: 10.7759/cureus.31887. eCollection 2022 Nov.

Authors

Adriano Bellotti¹, Simrat Arora¹, Chelsea Gustafson¹, Ian Funk¹, Craig Grossheusch¹, Carter Simmers¹, Quefeng Li², Yutong Liu², Alan Smeltz¹

Affiliations

¹ Department of Anesthesiology, University of North Carolina, Chapel Hill, USA.
² Department of Biostatistics, University of North Carolina, Chapel Hill, USA.

Abstract

Purpose The purpose is to identify predictors of post-induction hypotension (PIH) during general anesthesia in a population of patients with varying degrees of pulmonary hypertension (PH). Methods This is a single-center, retrospective, observational study of perioperative data obtained via electronic health records from patients with PH undergoing surgery over a five-year period. Baseline patient characteristics, peri-induction management variables, and pre-induction mean arterial pressure (MAP) were statistically analyzed using Kruskal-Wallis rank sum tests, Pearson's chi-squared tests, and logistic regression analysis to identify risk factors for PIH. We further assessed the relationship between PH and PIH using propensity score matching. Primary outcomes include a percent decrease in post-induction blood pressure as well as a post-induction nadir with a threshold of 55 mm Hg. Results Eight hundred fifty-seven patients in the cohort stratified by severity of PH reveal that advanced age (p < 0.001), higher BMI (P = 0.002), higher American Society of Anesthesiologists (ASA) score (P = 0.001), and renal and cardiac comorbidities (P < 0.001) are associated with PH severity. None of our tested parameters were significantly predictive for PIH in patients with PH. Right heart failure was found to be weakly and non-significantly predictive of PIH in patients with PH (P = 0.052, odds ratio [OR] = 1.116). Diabetes (P = 0.007, OR = 0.919) and maintenance of spontaneous ventilation (P = 0.012, OR = 0.925) were associated with decreased rates of PIH. Conclusion Hypotension after induction of general anesthesia in patients with PH is a serious problem, yet statistically significant risk factors were not identified. History of diabetes and preservation of spontaneous ventilation had a significant but weak effect of decreasing rates of PIH. This pilot study was limited by retrospective design and warrants further analysis with a prospective cohort.

Keywords: anesthesia; mean arterial pressure; post-induction hypotension; pulmonary hypertension; surgical risk factors.