title: High BMI in children as a risk factor for intraoperative hypotension.
abstract: BACKGROUND
  childhood obesity is a risk factor for many perioperative complications. Hypotension is a well described complication of general anaesthesia in both adults and children. This observational study compared the incidence of preincision hypotension (PIH) between children with high BMI and lean controls.
  
  
  METHODS
  children aged 2-17 years undergoing noncardiac procedures were classified into high or normal BMI groups. The incidence of PIH was then compared between the two groups using SBP data abstracted from our electronic anaesthesia monitoring system. Binary logistic regression was used to examine factors associated with the likelihood of PIH.
  
  
  RESULTS
  the study population was 19 400 children (54% boys) with a mean (SD) age of 8.3 ± 4.7 years and BMI of 19.3 ± 5.7 kg m(-2). Most (94.7%) of the patients were elective American Society of Anesthesiology I-II (79.7%) procedures. Single episode of PIH occurred in 36.8% of patients, whereas 8.3% had at least three episodes of PIH. PIH was more frequent in children with high BMI than their lean peers (40.9 vs. 31.4%, P < 0.001). Independent predictors of PIH were high BMI, high American Society of Anesthesiology status, propofol coinduction, baseline hypotension, age and preincision duration.
  
  
  CONCLUSIONS
  these results imply that children with high BMI have a higher incidence of hypotension than their lean peers following induction of anaesthesia for noncardiac procedures.
authors.affiliation: Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan 48109-0048, USA. onafiu@med.umich.edu
authors.forename: Olubukola O
authors.initials: OO
authors.lastname: Nafiu
authors.forename: Sarah
authors.initials: S
authors.lastname: Maclean
authors.forename: James
authors.initials: J
authors.lastname: Blum
authors.forename: Sachin
authors.initials: S
authors.lastname: Kheterpal
authors.forename: Andy
authors.initials: A
authors.lastname: Cowan
authors.forename: Kevin K
authors.initials: KK
authors.lastname: Tremper
mesh_terms: D000293:Adolescent; D000367:Age Factors; D000768:Anesthesia, General / Q000009:adverse effects / Q000379:methods; D018686:Anesthetics, Intravenous / Q000008:administration & dosage / Q000009:adverse effects; D015992:Body Mass Index; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007022:Hypotension / Q000453:epidemiology / Q000209:etiology*; D007431:Intraoperative Complications / Q000453:epidemiology / Q000209:etiology*; D016015:Logistic Models; D008297:Male; D016343:Monitoring, Intraoperative / Q000379:methods; D009765:Obesity / Q000150:complications*; D015742:Propofol / Q000008:administration & dosage / Q000009:adverse effects; D012307:Risk Factors
chemical_list: D018686:Anesthetics, Intravenous; D015742:Propofol