Study Reveals Echocardiography and Anesthetic Impact on Anesthesia Hypotension

In the realm of general anesthesia, the prediction and prevention of complications are paramount to ensuring positive postoperative outcomes. Perioperative hypotension, a common concern, is strongly linked to severe complications like myocardial injury, stroke, and renal damage. Post-induction hypotension (PIH) during general anesthesia is particularly worrisome due to its high incidence and association with adverse outcomes. Various indicators have been proposed to predict PIH, such as age, diabetes, and preoperative vena cava diameter. However, the predictors of PIH have not been fully elucidated, necessitating further investigation.

A previous study suggested that assessing regional wall motion abnormality (RWMA) and E/e’ using preoperative echocardiography could help stratify patients at risk of PIH. However, this study was limited in scope, focusing only on surgical cases where echocardiography was performed. Preoperative echocardiography is not universally recommended for all non-cardiac surgery patients, especially those deemed low-risk. Yet, evidence suggests that echocardiography during the perioperative period may significantly reduce complications in high-risk individuals with cardiac abnormalities.

A recent prospective observational study aimed to explore the predictive value of preoperative echocardiography, anesthetic agents, patient comorbidities, and medications in determining postoperative mean blood pressure (PIB) in patients undergoing general anesthesia. The study enrolled 1,603 patients scheduled for surgery, with echocardiography performed in 384 patients. The incidence of PIH was higher in the group that underwent echocardiography compared to those who did not.

The study revealed that RWMA and lower estimated glomerular filtration rate were associated with lower PIB, while factors like high BMI, beta blockers, and sevoflurane use were associated with higher PIB. Notably, an interaction between sevoflurane and RWMA was identified, suggesting that sevoflurane could help maintain blood pressure during anesthesia induction in patients with RWMA. The study also highlighted the potential benefits of prophylactic norepinephrine use in preventing PIH.

The findings of this study offer insights into the role of echocardiography and anesthetic agents in predicting and managing PIH during general anesthesia. By identifying high-risk patients and tailoring anesthetic interventions accordingly, anesthesiologists can potentially reduce the incidence of PIH and improve postoperative outcomes. Further research is needed to validate these findings and optimize perioperative strategies for better patient care.