Cautious Optimism: Can Preoperative Ultrasound Predict Postinduction Hypotension?
Cautious Optimism: Can Preoperative Ultrasound Predict Postinduction Hypotension?
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谨慎乐观：术前超声可以预测诱导后低血压吗？
DOI：
10.1097/aln.0000000000001003
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发表时间：
2016
期刊：
影响因子：
8.8
通讯作者：
Subramaniam,Kathirvel
中科院分区：
文献类型：
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作者：
Subramaniam,Balachundhar;Subramaniam,Kathirvel
全身麻醉期间低血压(MAP<；55 mm汞)即使持续很短的时间也可能导致术后期间的主要不良事件(MAE)。1全身麻醉诱导后发生低血压的可能性可以通过以下措施来降低：a)根据患者的术前状态使用适当的剂量和给药速率；b)对被确定为在诱导期间出现血流动力学不稳定的高风险患者预防性地给予液体和血管活性药物。在此背景下，这项研究发表在最新一期的麻醉学杂志上，“全麻前的下腔静脉超声可以预测诱导后的低血压。”是有临床意义的。2作者得出结论，在美国麻醉师协会(ASA)身体状况为I-III级的手术患者中，75%的患者术前使用护理点超声扫描下腔静脉(IVC-CI)和评估下腔静脉塌陷指数(IVC-CI)可以可靠地预测诱导后低血压(定义为MAP和Lt；60 mm汞或30%平均血压，MBP较基线下降)。当IVC-CI>43%时可预测低血压。由于太多的患者处于不可预测或灰色地带(59%)，单独评估下腔静脉大小在临床上的用处较少。目前，我们使用静态参数如中心静脉压、肺动脉压以及动态液体反应性标记物如每搏输出量、心脏指数、脉压变化和体积图变化来评估和优化围手术期的液体状态。测量这些参数需要进行侵入性操作(动脉、中心线或肺动脉
Hypotension (MAP< 55 mm of Hg) during general anesthesia lasting for even short periods of time can lead to major adverse events (MAE) in the postoperative period. 1 Hypotension following induction of general anesthesia can be made less likely by a) using proper dosing and rate of administration of specific drugs tailored to the patient’s preoperative status and b) prophylactic administration of fluids and vasoactive medications to patients identified as high risk for developing hemodynamic instability during induction. In this context, the study published in the current issue of Anesthesiology,“Inferior Vena Cava Ultrasonography prior to General Anesthesia can Predict Hypotension after Induction.” is of clinical relevance. 2 The authors conclude that preoperative scanning of Inferior Vena Cava (IVC) with point of care ultrasound and assessment of IVC collapsibility index (IVC-CI) can reliably predict hypotension (defined as MAP< 60mm of Hg or a 30% mean blood pressure, MBP, decrease from baseline) following induction in 75% of patients with American Society of Anesthesiologists (ASA) physical status I-III undergoing surgery. Hypotension was predicted when IVC-CI was greater than 43%. Assessment of IVC size alone was less clinically useful, due to the reason that too many patients were in the unpredictable or gray zone (59%).Currently, we use static parameters such as central venous pressure, pulmonary artery pressure as well as dynamic markers of fluid responsiveness such as delta stroke volume, delta cardiac index, pulse pressure variation and plethysmographic variations in the perioperative period to assess and optimize fluid status. Measurement of these parameters necessitates an invasive procedure (arterial line, central line or pulmonary arterial