Hypotension in anaesthetized patients during aneurysm clipping: not as bad as expected? Export

@article{citeulike:3182973, abstract = {Departments of 1Perioperative \& Emergency Care and 2Neurology and Neurosurgery, Rudolf Magnus Institute of Neuroscience, University Medical Centre Utrecht, Utrecht, the Netherlands, 3Department of Neurology, Canisius Wilhelmina Hospital, Nijmegen, the Netherlands and 4Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, the Netherlands Correspondence to Address: Reinier G. Hoff Department of Perioperative \& Emergency Care, Q 04.2.303 University Medical Centre Utrecht PO Box 85500 3508 GA Utrecht The Netherlands e-mail: r.hoff@umcutrecht.nl KEYWORDS Intracranial aneurysm • subarachnoid haemorrhage • hypotension • brain ischaemia ABSTRACT Background: Patients with aneurysmal subarachnoid haemorrhage (SAH) often have disturbed autoregulation of cerebral blood flow. A reduction in systemic blood pressure during surgery may therefore lead to delayed cerebral ischaemia (DCI). To assess the incidence and severity of intra-operative hypotension, we performed a retrospective cohort study in 164 patients with recent SAH and surgical clipping of the aneurysm. Methods: Intra-operative hypotension was defined in three levels of severity, as a decrease in mean arterial pressure (ΔMAP) of more than 30\%, 40\% or 50\% compared with the pre-operative pressure. For each patient the total amount of time with intra-operative hypotension was retrieved. Logistic regression analysis was performed to study the relation between intra-operative hypotension and the occurrence of DCI and poor outcome. Results: A period with ΔMAP>30\% occurred in 128 patients (78\%) with a median duration of this period of 105 min (25–75‰ 50–171 min). ΔMAP>40\% occurred in 88 patients (54\%) and ΔMAP>50\% occurred in 22 patients (13\%). In univariate analysis, ΔMAP>50\% was associated with poor outcome. After adjusting for age and World Federation of Neurological Surgeons grade, the association with poor outcome was no longer statistically significant [odds ratio (OR) 1.018; 95\% CI 0.996–1.041]. Conclusion: Hypotension during surgical clipping of intracranial aneurysms occurred frequently. In our study population of patients mostly in good clinical condition, hypotension was not confirmed as an independent risk factor for DCI or poor outcome. Anaesthesia may have had a cerebral protective effect.}, author = {Hoff, R. G. and Dijk, Van G. W. and Mettes, S. and Verweij, B. H. and Algra, A. and Rinkel, G. J. E. and Kalkman, C. J.}, citeulike-article-id = {3182973}, citeulike-linkout-0 = {http://www3.interscience.wiley.com/cgi-bin/fulltext/120119470/HTMLSTART}, keywords = {aneurysm, hypotension}, posted-at = {2008-09-02 21:35:53}, priority = {2}, title = {Hypotension in anaesthetized patients during aneurysm clipping: not as bad as expected?}, url = {http://www3.interscience.wiley.com/cgi-bin/fulltext/120119470/HTMLSTART} }

TY - JOUR ID - citeulike:3182973 L3 - citeulike-article-id:3182973 N2 - Departments of 1Perioperative & Emergency Care and 2Neurology and Neurosurgery, Rudolf Magnus Institute of Neuroscience, University Medical Centre Utrecht, Utrecht, the Netherlands, 3Department of Neurology, Canisius Wilhelmina Hospital, Nijmegen, the Netherlands and 4Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, the Netherlands Correspondence to Address: Reinier G. Hoff Department of Perioperative & Emergency Care, Q 04.2.303 University Medical Centre Utrecht PO Box 85500 3508 GA Utrecht The Netherlands e-mail: r.hoff@umcutrecht.nl KEYWORDS Intracranial aneurysm • subarachnoid haemorrhage • hypotension • brain ischaemia ABSTRACT Background: Patients with aneurysmal subarachnoid haemorrhage (SAH) often have disturbed autoregulation of cerebral blood flow. A reduction in systemic blood pressure during surgery may therefore lead to delayed cerebral ischaemia (DCI). To assess the incidence and severity of intra-operative hypotension, we performed a retrospective cohort study in 164 patients with recent SAH and surgical clipping of the aneurysm. Methods: Intra-operative hypotension was defined in three levels of severity, as a decrease in mean arterial pressure (ΔMAP) of more than 30%, 40% or 50% compared with the pre-operative pressure. For each patient the total amount of time with intra-operative hypotension was retrieved. Logistic regression analysis was performed to study the relation between intra-operative hypotension and the occurrence of DCI and poor outcome. Results: A period with ΔMAP>30% occurred in 128 patients (78%) with a median duration of this period of 105 min (25–75‰ 50–171 min). ΔMAP>40% occurred in 88 patients (54%) and ΔMAP>50% occurred in 22 patients (13%). In univariate analysis, ΔMAP>50% was associated with poor outcome. After adjusting for age and World Federation of Neurological Surgeons grade, the association with poor outcome was no longer statistically significant [odds ratio (OR) 1.018; 95% CI 0.996–1.041]. Conclusion: Hypotension during surgical clipping of intracranial aneurysms occurred frequently. In our study population of patients mostly in good clinical condition, hypotension was not confirmed as an independent risk factor for DCI or poor outcome. Anaesthesia may have had a cerebral protective effect. TI - Hypotension in anaesthetized patients during aneurysm clipping: not as bad as expected? KW - aneurysm KW - hypotension AU - Hoff, RG AU - Dijk, Van AU - Mettes, S AU - Verweij, BH AU - Algra, A AU - Rinkel, GJE AU - Kalkman, CJ UR - http://www3.interscience.wiley.com/cgi-bin/fulltext/120119470/HTMLSTART ER -