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Patient and anesthesia characteristics of children with low pre-incision blood pressure: A retrospective
Wietze Pasma1, Linda M Peelen1,2, Stefanie van den Broek1
1Department of Anesthesiology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
Insights
Children with low pre-incision blood pressure during anesthesia do not differ significantly from those with normal blood pressure. This study explored factors influencing pediatric blood pressure before surgery, finding minor associations with patient and anesthetic characteristics.
Area of Science:
- Anesthesiology
- Pediatric Medicine
- Cardiovascular Physiology
Background:
- Intraoperative blood pressure is critical for safe pediatric anesthesia.
- Limited understanding exists regarding factors differentiating children with low vs. normal pre-incision blood pressure.
- This study focuses on the pre-incision period to identify such differentiating factors.
Purpose of the Study:
- To explore whether children with low pre-incision blood pressure during anesthesia differ from those with normal blood pressure.
- To identify patient and anesthetic characteristics associated with low pre-incision blood pressure in pediatric patients.
- To investigate the role of various factors in predicting pre-incision blood pressure in pediatric anesthesia.
Main Methods:
- Retrospective analysis of 20,962 pediatric anesthetic cases for non-cardiac surgery (2012-2016).
- Comparison of patient and anesthesia characteristics between low and normal pre-incision blood pressure groups.
- Multivariable linear regression used to explore associations with pre-incision blood pressure.
Main Results:
- Pre-incision blood pressure showed associations with age, gender, previous surgery, preoperative blood pressure, epilepsy, and bronchial hyperactivity.
- Anesthetic factors such as emergency surgery, loco-regional technique, airway device, and sevoflurane concentration were also associated.
- Specific associations included: age (beta -0.04 SD/year), female gender (-0.11), epilepsy (0.12), and loco-regional technique (-0.48).
Conclusions:
- Children with low pre-incision blood pressure do not exhibit clinically significant differences compared to those with normal blood pressure.
- Pre-incision blood pressure is influenced by both patient characteristics and anesthetic techniques.
- Unmeasured variables may play a more substantial role in determining pre-incision blood pressure in pediatric anesthesia.
Background:
Intraoperative blood pressure has been suggested as a key factor for safe pediatric anesthesia. However, there is not much insight into factors that discriminate between children with low and normal pre-incision blood pressure. Our aim was to explore whether children who have a low blood pressure during anesthesia are different than those with normal blood pressure. The focus of the present study was on the pre-incision period.
Methods:
This retrospective study included pediatric patients undergoing anesthesia for non-cardiac surgery at a tertiary pediatric university hospital, between 2012 and 2016. We analyzed the association between pre-incision blood pressure and patient- and anesthesia characteristics, comparing low with normal pre-incision blood pressure. This association was further explored with a multivariable linear regression.
Results:
In total, 20 962 anesthetic cases were included. Pre-incision blood pressure was associated with age (beta -0.04 SD per year), gender (female -0.11), previous surgery (-0.15), preoperative blood pressure (+0.01 per mm Hg), epilepsy (0.12), bronchial hyperactivity (-0.18), emergency surgery (0.10), loco-regional technique (-0.48), artificial airway device (supraglottic airway device instead of tube 0.07), and sevoflurane concentration (0.03 per sevoflurane %).
Conclusions:
Children with low pre-incision blood pressure do not differ on clinically relevant factors from children with normal blood pressure. Although the present explorative study shows that pre-incision blood pressure is partly dependent on patient characteristics and partly dependent on anesthetic technique, other unmeasured variables might play a more important role.
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