Risk factors including preoperative echocardiographic parameters for post-induction hypotension in general anesthesia

Severe hypotension immediately after induction of general anesthesia (post-induction hypotension) is a common complication and is associated with a poor postoperative outcome. We hypothesized that post-induction hypotension results from cardiac dysfunction which can be assessed by preoperative echocardiography.

We retrospectively enrolled 200 patients who had undergone elective surgery within 6 months after preoperative transthoracic echocardiography. The incidence of post-induction hypotension identified from anesthesia records was defined as a decrease in mean blood pressure to ≤50 mmHg after injection of induction anesthetics prior to surgery. Logistic regression analysis of patient characteristics and echocardiographic variables was used to identify the independent factors for post-induction hypotension.

Post-induction hypotension was found in 63 of the 200 cases (incidence 32%). Independent risk factors for post-induction hypotension were the presence of a regional wall motion abnormality (RWMA) [odds ratio (OR), 6.65.; 95% confidence interval (CI), 1.76 - 25.10], an elevated E/e' (OR, 1.13; 95% CI, 1.00 - 1.28), female gender (OR, 3.61; 95% CI, 1.37 - 9.56), and the use of an angiotensin II receptor blocker (OR, 3.17; 95% CI, 1.12 - 8.96).

Assessment of RWMA and E/e' with preoperative transthoracic echocardiography might be helpful for stratification of patients at a risk of post-induction hypotension in general anesthesia.