title: Preoperative Hypercapnia as a Predictor of Hypotension During Anesthetic Induction in Lung Transplant Recipients.
abstract: OBJECTIVE
  To determine the incidence and predisposing factors of hypotension during anesthetic induction in lung transplant recipients.
  
  
  METHODS
  Retrospective study.
  
  
  METHODS
  University hospital.
  
  
  METHODS
  Patients who underwent lung transplantation between 2008 and 2013 (n = 68).
  
  
  METHODS
  None.
  
  
  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.
authors: Departments of Anesthesia. Electronic address: mizota@kuhp.kyoto-u.ac.jp.
authors: Toshiyuki
authors: T
authors: Mizota
authors: Departments of Anesthesia.
authors: Shino
authors: S
authors: Matsukawa
authors: Departments of Anesthesia.
authors: Hiroshi
authors: H
authors: Fukagawa
authors: Departments of Anesthesia.
authors: Hiroki
authors: H
authors: Daijo
authors: Departments of Anesthesia.
authors: Tomoharu
authors: T
authors: Tanaka
authors: Thoracic Surgery, Kyoto University Hospital, Kyoto, Japan.
authors: Fengshi
authors: F
authors: Chen
authors: Thoracic Surgery, Kyoto University Hospital, Kyoto, Japan.
authors: Hiroshi
authors: H
authors: Date
authors: Departments of Anesthesia.
authors: Kazuhiko
authors: K
authors: Fukuda
mesh_terms: D000293:Adolescent; D000328:Adult; D000758:Anesthesia / Q000009:adverse effects* / Q000639:trends; D002648:Child; D005260:Female; D006801:Humans; D006935:Hypercapnia / Q000175:diagnosis* / Q000453:epidemiology; D007022:Hypotension / Q000175:diagnosis* / Q000453:epidemiology; D016040:Lung Transplantation / Q000009:adverse effects* / Q000639:trends; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011300:Preoperative Care / Q000379:methods* / Q000639:trends; D012189:Retrospective Studies; D066027:Transplant Recipients; D055815:Young Adult
keywords: anesthetic induction; hypercapnia; hypotension; lung transplantation