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Title: Preoperative Hypercapnia as a Predictor of Hypotension during Anesthetic Induction in Lung Transplant Recipients
Authors: Mizota, Toshiyuki  kyouindb  KAKEN_id  orcid https://orcid.org/0000-0003-2770-4262 (unconfirmed)
Matsukawa, Shino
Fukagawa, Hiroshi
Daijo, Hiroki
Tanaka, Tomoharu  kyouindb  KAKEN_id
Chen, Fengshi
Date, Hiroshi
Fukuda, Kazuhiko  kyouindb  KAKEN_id
Author's alias: 溝田, 敏幸
松川, 志乃
深川, 博志
大条, 紘樹
田中, 具治
陳, 豊史
伊達, 洋至
福田, 和彦
Keywords: lung transplantation
anesthetic induction
hypotension
hypercapnia
Issue Date: Aug-2015
Publisher: Elsevier Inc.
Journal title: Journal of Cardiothoracic and Vascular Anesthesia
Volume: 29
Issue: 4
Start page: 967
End page: 971
Abstract: 【Objective】 To determine the incidence and predisposing factors of hypotension during anesthetic induction in lung transplant recipients. 【Design】 Retrospective study. 【Setting】 University hospital. 【Participants】 Patients who underwent lung transplantation between 2008 and 2013 (n = 68). 【Interventions】None. 【Measurements and Main Results】 The authors analyzed the mean arterial pressure (MAP) from administration of anesthetic drugs to 10 minutes after endotracheal intubation (ie, the anesthetic induction) among participants who underwent lung transplantation. Patients were considered to have clinically significant hypotension (CSH) when the following criteria were fulfilled: An MAP decrease of>40% from baseline and MAP of<60 mmHg. Overall, 41.2% of patients experienced CSH during the induction of anesthesia. The preoperative partial pressure of carbon dioxide (PaCO2) was significantly higher in patients who experienced CSH during anesthetic induction than in those who did not (p = 0.005). Preoperative PaCO2 predicted the development of CSH during anesthetic induction (area under the curve = 0.702; p = 0.002), with an optimal cut-off point of 55 mmHg determined by maximizing the Youden index. The incidences of CSH during anesthetic induction for patients with (PaCO2≥55) and without (PaCO2<55) preoperative hypercapnia were 75.0% (95% confidence interval [CI] [53.8-89.2]) and 30.8% (95% CI 26.4-37.3), respectively. After adjustment for known predicting factors, the odds ratio for the relationship between preoperative hypercapnia and CSH during anesthetic induction was 12.54 (95% CI 3.10-66.66). 【Conclusions】 Hypotension during anesthetic induction is common in lung transplant recipients, and is independently predicted by preoperative hypercapnia.
Rights: © 2015. This manuscript version is made available under the CC-BY-NC-ND 4.0 license http://creativecommons.org/licenses/by-nc-nd/4.0/
The full-text file will be made open to the public on 01 August 2016 in accordance with publisher's 'Terms and Conditions for Self-Archiving'
This is not the published version. Please cite only the published version. この論文は出版社版でありません。引用の際には出版社版をご確認ご利用ください。
URI: http://hdl.handle.net/2433/225948
DOI(Published Version): 10.1053/j.jvca.2014.10.027
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