ncidence and Risk Factors for Pre-Incision Hypotension in a Pediatric Surgical Population. Export

@article{citeulike:3182991, abstract = {Introduction: Routine monitoring of blood pressure is an essential part of peri-operative care in adults and children (1). Data from adult (1) and pediatric victims of trauma (2) suggests that systolic BP is a predictor of mortality. Intra-operative hypotension (IOH) in adults is a common occurrence and it may be associated with early and long-term morbidity and mortality (3). It seems that patients are particularly prone to IOH in the pre-incision period. Although pediatric anesthesiologists daily monitor blood pressure, there is no clinically useful definition of hypotension in the pediatric anesthesia literature. Consequently there is no data on the incidence of hypotension. This study had two objectives: (1) to use PALS definition of hypotension to define the incidence of pre-incision hypotension (PIH) in a pediatric non-cardiac surgical population and (2) to identify risk factors for the occurrence pre-incision hypotension in the same population of children. Methods: We examined the electronic peri-operative records of all children aged 1-18yr undergoing general anesthesia between Jan 2005 and Jun 2007 in our institution. PIH was defined as any SBP < 5th percentile for age (Brain Trauma Foundation Guidelines Definition: 2 x (age in yrs) + 70 mm Hg. Each intra-operative anesthetic record was divided into consecutive ten-minute epochs and the median systolic blood pressure (SBP) for each ten-minute epoch was calculated. This filters out monitoring artifacts and clinically transient hypotension (3). Frequency and factors associated with PIH were computed. Binary logistic regression with forward step-wise algorithm was used to examine factors associated with the likelihood of PIH. Results After excluding cardiac cases and children with missing or implausible pre-op and intra-op SBP we had complete data on 20413 children of whom 57.3\% were males. Most (94.9\%) cases were elective, ASA I-II (81.9\%) procedures. Inhalational induction was predominantly used in this cohort (73.4\%). Single or multiple episodes of PIH occurred in 33.8\% of patients. PIH was more common in patients of ASA >II (p < 0.001); males (p = 0.02); those with pre-operative hypotension (p < 0.001); and following intravenous induction (P<0.001). On Multivariate analysis the following were significant predictors of PIH: Use of IV induction, ASA III-IV, Pre-existing hypotension and BMI category. [table1]Conclusion: PIH is common in the pediatric surgical population undergoing general anesthesia. Factors independently predictive of PIH such as high ASA status, pre-existing hypotension, IV induction and adolescent age group Whereas IOH hypotension may not have the same cardiac and neurologic consequences in children as in adults, it is a physiologic aberration that needs to be prevented and promptly treated. Future prospective studies should examine early and long-time (neuro-cognitive?) consequences of isolated or prolonged IOH in children. References: (1) J Trauma 1993; 34:216–222. (2) J Pediatr Surg 1998;33: 333–338. (3) Anesth Analg 2005; 100:4–10.}, author = {Nafiu, Olubukola O. and Sachin}, citeulike-article-id = {3182991}, citeulike-linkout-0 = {http://www.asaabstracts.com/strands/asaabstracts/searchArticle.htm;jsessionid=32C45441CA9439F0CE695A76F1E806CE?index=0&#38;highlight=true&#38;highlightcolor=0&#38;bold=true&#38;italic=false}, keywords = {anesthesia, hypotension, pediatric}, posted-at = {2008-09-02 21:52:53}, priority = {2}, title = {ncidence and Risk Factors for Pre-Incision Hypotension in a Pediatric Surgical Population.}, url = {http://www.asaabstracts.com/strands/asaabstracts/searchArticle.htm;jsessionid=32C45441CA9439F0CE695A76F1E806CE?index=0&#38;highlight=true&#38;highlightcolor=0&#38;bold=true&#38;italic=false} }

TY - JOUR ID - citeulike:3182991 L3 - citeulike-article-id:3182991 N2 - Introduction: Routine monitoring of blood pressure is an essential part of peri-operative care in adults and children (1). Data from adult (1) and pediatric victims of trauma (2) suggests that systolic BP is a predictor of mortality. Intra-operative hypotension (IOH) in adults is a common occurrence and it may be associated with early and long-term morbidity and mortality (3). It seems that patients are particularly prone to IOH in the pre-incision period. Although pediatric anesthesiologists daily monitor blood pressure, there is no clinically useful definition of hypotension in the pediatric anesthesia literature. Consequently there is no data on the incidence of hypotension. This study had two objectives: (1) to use PALS definition of hypotension to define the incidence of pre-incision hypotension (PIH) in a pediatric non-cardiac surgical population and (2) to identify risk factors for the occurrence pre-incision hypotension in the same population of children. Methods: We examined the electronic peri-operative records of all children aged 1-18yr undergoing general anesthesia between Jan 2005 and Jun 2007 in our institution. PIH was defined as any SBP < 5th percentile for age (Brain Trauma Foundation Guidelines Definition: 2 x (age in yrs) + 70 mm Hg. Each intra-operative anesthetic record was divided into consecutive ten-minute epochs and the median systolic blood pressure (SBP) for each ten-minute epoch was calculated. This filters out monitoring artifacts and clinically transient hypotension (3). Frequency and factors associated with PIH were computed. Binary logistic regression with forward step-wise algorithm was used to examine factors associated with the likelihood of PIH. Results After excluding cardiac cases and children with missing or implausible pre-op and intra-op SBP we had complete data on 20413 children of whom 57.3% were males. Most (94.9%) cases were elective, ASA I-II (81.9%) procedures. Inhalational induction was predominantly used in this cohort (73.4%). Single or multiple episodes of PIH occurred in 33.8% of patients. PIH was more common in patients of ASA >II (p < 0.001); males (p = 0.02); those with pre-operative hypotension (p < 0.001); and following intravenous induction (P<0.001). On Multivariate analysis the following were significant predictors of PIH: Use of IV induction, ASA III-IV, Pre-existing hypotension and BMI category. [table1]Conclusion: PIH is common in the pediatric surgical population undergoing general anesthesia. Factors independently predictive of PIH such as high ASA status, pre-existing hypotension, IV induction and adolescent age group Whereas IOH hypotension may not have the same cardiac and neurologic consequences in children as in adults, it is a physiologic aberration that needs to be prevented and promptly treated. Future prospective studies should examine early and long-time (neuro-cognitive?) consequences of isolated or prolonged IOH in children. References: (1) J Trauma 1993; 34:216–222. (2) J Pediatr Surg 1998;33: 333–338. (3) Anesth Analg 2005; 100:4–10. TI - ncidence and Risk Factors for Pre-Incision Hypotension in a Pediatric Surgical Population. KW - anesthesia KW - hypotension KW - pediatric AU - Nafiu, Olubukola AU - Sachin UR - http://www.asaabstracts.com/strands/asaabstracts/searchArticle.htm;jsessionid=32C45441CA9439F0CE695A76F1E806CE?index=0&#38;highlight=true&#38;highlightcolor=0&#38;bold=true&#38;italic=false ER -