title: Pre-existing arterial stiffness can predict hypotension during induction of anaesthesia in the elderly.
abstract: BACKGROUND
  The aim of the present study was to establish whether elevated carotid-femoral pulse wave velocity (c-fPWV), an indicator of aortic stiffness, assessed before surgery, is correlated with variations in arterial pressure (AP) during induction of anaesthesia in elderly patients undergoing non-cardiovascular surgery.
  
  
  METHODS
  c-fPWV was measured with the PulsePen(®) device during pre-surgical anaesthetic evaluation. Monitoring included electrocardiography, pulse oximetry, non-invasive AP, heart rate, bispectral index (BIS), and oxygen concentration during induction of anaesthesia with propofol and remifentanil. Anaesthesia was induced so as to maintain BIS values between 40 and 50.
  
  
  RESULTS
  Forty-five patients, aged [mean (sd)] 71.1 (5.8) yr, were studied. The mean value of c-fPWV was 12.1 (3.9) m s⁻¹. There was no correlation between hypotension during anaesthesia induction and total dosage or rate of administration of propofol or remifentanil. In univariate analysis, only age and PWV significantly correlated with the decreases in AP, and the association between c-fPWV and a decrease in AP was also seen in multivariate analysis (r = 0.36, P< 0.05). Patients classified as having 'high stiffness' (c-fPWV ≥ 12.9 m s⁻¹) had 25% further decrease in systolic AP during anaesthesia induction than those with lower PWV [75.2 (5.7) vs 60.2 (4.2) mm Hg, P < 0.05].
  
  
  CONCLUSIONS
  Increased aortic stiffness, as assessed by PWV measured during preoperative anaesthetic evaluation, is associated with more pronounced hypotension during induction of anaesthesia. Measurement of aortic stiffness in the elderly may thus represent a valid indicator of the risk of hypotension during anaesthesia induction.
authors.affiliation: Department of Geriatrics, CHU Nancy, Brabois Hospital, 54500 Vandoeuvre, France. c.alecu@chu-nancy.fr
authors.forename: C
authors.initials: C
authors.lastname: Alecu
authors.forename: E
authors.initials: E
authors.lastname: Cuignet-Royer
authors.forename: P M
authors.initials: PM
authors.lastname: Mertes
authors.forename: P
authors.initials: P
authors.lastname: Salvi
authors.forename: H
authors.initials: H
authors.lastname: Vespignani
authors.forename: M
authors.initials: M
authors.lastname: Lambert
authors.forename: H
authors.initials: H
authors.lastname: Bouaziz
authors.forename: A
authors.initials: A
authors.lastname: Benetos
mesh_terms: D000368:Aged; D000768:Anesthesia, General / Q000379:methods; D001011:Aorta / Q000503:physiopathology*; D019644:Arthroplasty, Replacement, Hip; D001783:Blood Flow Velocity / Q000502:physiology; D017536:Carotid Artery, Common / Q000503:physiopathology; D005260:Female; D005263:Femoral Artery / Q000503:physiopathology; D006801:Humans; D007022:Hypotension / Q000175:diagnosis*; D007431:Intraoperative Complications / Q000175:diagnosis*; D008297:Male; D008365:Manometry / Q000379:methods; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods; D011300:Preoperative Care / Q000379:methods; D011446:Prospective Studies; D011673:Pulsatile Flow / Q000502:physiology; D012307:Risk Factors; D014655:Vascular Resistance / Q000502:physiology*