Predictors of Hypotension After Induction of General Anesthesia

Authors:
  • SHSabera Hossain
    Sabera Hossain
  • MKMarina Krol
    Marina Krol
  • BBBernard Baez
    Bernard Baez
  • PPPuja Patel
    Puja Patel
  • ABAriel Bernstein
    Ariel Bernstein
  • CBCarol A. Bodian
    Carol A. Bodian
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Abstract
Hypotension after induction of general anesthesia is a common event. In the current investigation, we sought to identify the predictors of clinically significant hypotension after the induction of general anesthesia. Computerized anesthesia records of 4096 patients undergoing general anesthesia were queried for arterial blood pressure (BP), demographic information, preoperative drug history, and anesthetic induction regimen. The median BP was determined preinduction and for 0-5 and 5-10 min postinduction of anesthesia. Hypotension was defined as either: mean arterial blood pressure (MAP) decrease of >40% and MAP or =50 yr, the use of propofol for induction of anesthesia, and increasing induction dosage of fentanyl. Smaller doses of propofol, etomidate, and thiopental were not associated with less hypotension. To avoid severe hypotension, alternatives to propofol anesthetic induction (e.g., etomidate) should be considered in patients older than 50 yr of age with ASA physical status > or =3. We conclude that it is advisable to avoid propofol induction in patients who present with baseline MAP <70 mm Hg.

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