Response to comment on: "Association of propofol induction dose and severe pre-incision hypotension among surgical patients over age 65".
Response to comment on: "Association of propofol induction dose and severe pre-incision hypotension among surgical patients over age 65".
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对以下评论的回应：“65 岁以上手术患者中异丙酚诱导剂量与严重切口前低血压的关联”。
DOI：
10.1016/j.jclinane.2022.110911
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发表时间：
2022
影响因子：
6.7
通讯作者：
Schonberger,RobertB
中科院分区：
文献类型：
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作者：
Bardia,Amit;Akhtar,Shamsuddin;Schonberger,RobertB
我们感谢Mandel博士提请注意我们的文章[1]，并感谢他的建设性批评，这将影响未来与丙泊酚相关血流动力学扰动这一重要主题相关的研究。我们相信他和其他主题专家会同意：a）麻醉诱导是一个关键的术中事件，B）它证明了与FDA指南相关的丙泊酚给药剂量和模式的临床实践模式存在显著差异[2]，（C）供应商对这些剂量模式的选择使患者面临不同的严重低血压风险。和其他人[3，4]，丙泊酚的给药速率是诱导后低血压的既定驱动因素。然而，与Mandel博士认为大型数据库（如MPOG联盟的数据库）可能无法处理这方面的护理相反，我们实际上希望强调，我们的报告为他关于给药速率对后续血流动力学影响的重要性的陈述提供了支持证据。在我们的研究中，我们观察到单次和多次丙泊酚诱导剂量与严重低血压的主要结局之间的相关性。事实上，在我们的两个主要模型中，多次分次给药（而不是单次给药）是与诱导后低血压几率较低相关的最强因素之一：无创血压队列中多次给药与单次给药优势比0.67（95% CI 0.64-0.69），p< 0.001;有创血压监测队列中多次给药与单次给药的比值比为0.72（95% CI 0.67-0.76），p< 0.001。
We thank Dr. Mandel for drawing attention to our article [1] and for his constructive criticism which will shape future studies related to this important topic of Propofolrelated hemodynamic perturbations. We trust he and other subject experts would agree that a) anesthetic induction is a crucial intraoperative event, that b) it demonstrates significant variability in clinical practice patterns regarding doses and patterns of Propofol administration in relation to FDA guidance [2], and that c) providers’ choices about these dose patterns expose patients to varying risks of severe hypotension.As eloquently argued by Dr. Mandel citing his work and others [3, 4], the rate of administration of Propofol is an established driver of post-induction hypotension. However, contrary to Dr. Mandel’s belief that large databases-such as the repository of the MPOG consortium-may be unable to approach this aspect of care, we in fact wish to emphasize that our report offers supporting evidence for his statements regarding the importance of rate of administration for subsequent hemodynamic effects. In our study, we observed an association of single vs. multiple Propofol induction doses with the primary outcome of severe hypotension. Indeed, multiple divided doses-as opposed to a single dose-was one of the strongest factors associated with lower odds of post induction hypotension in both of our primary models: Multiple doses vs. Single dose in non-invasive blood pressure cohort Odds Ratio 0.67 (95% CI 0.64–0.69), p< 0.001; Multiple doses vs. Single dose in invasive blood pressure monitoring cohort Odds Ratio 0.72 (95% CI 0.67–0.76), p< 0.001.