Pulse Pressure Variation and Weight-Loss Percentage Predict Hypotension After Anesthesia Induction in Neurosurgery Patients: A Prospective, Observational, Blinded Study.
BACKGROUND
Hypotension after anesthesia induction is a common problem and is partly related to patient volume status. The present study aimed to investigate the correlation between blood pressure change and pulse pressure variation (PPV), and percentage of weight loss while determining threshold for hypotension by receiver operating characteristic analysis.


METHODS
We analyzed 231 neurosurgery patients. In all patients, propofol was used for standard anesthesia induction. Patient demographics, medical histories, fasting duration, percentage weight loss, baseline blood pressure, and PPV during normal tidal volume breathing and that during forced inspiratory breathing (PPVfi) were recorded. Hemodynamic changes within 10 minutes of intubation were observed. Patients developing hypotension and severe hypotension were determined; lowest mean arterial pressure (MAP) and systolic arterial pressure (SAP) values were recorded, and their differences relative to baseline values were calculated.


RESULTS
The incidence of hypotension was 18.6%. Both percentage weight loss and PPVfi were correlated with the changes in MAP and SAP. A PPVfi>14 identified all observed hypotensive episodes with 86% sensitivity and 86.2% specificity, whereas percentage weight loss >1.75% identified all observed hypotensive episodes with 81.4% sensitivity and 70.7% specificity. Furthermore, PPVfi>16.5 identified severe hypotension with 85% sensitivity and 90.5% specificity, whereas percentage weight loss >1.95% identified severe hypotension with 85% sensitivity and 73% specificity.


CONCLUSIONS
Percentage weight loss and PPVfi are good predictors of hypotension after anesthesia induction and, thus, may allow anesthesiologists to adopt preventative measures and ensure safer anesthesia induction.
Department of Anesthesiology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey.
Achmet
A
Ali
Oguzhan
O
Altiparmak
Aylin
A
Tetik
Demet
D
Altun
Nukhet
N
Sivrikoz
Mehmet
M
Buget
Sahika
S
Bolsoy
Nihan
N
Yaman
Ibrahim O
IO
Akinci
D000328:Adult; D000368:Aged; D000758:Anesthesia / Q000009:adverse effects*; D062186:Arterial Pressure; D001794:Blood Pressure / Q000502:physiology*; D005260:Female; D006439:Hemodynamics; D006801:Humans; D007022:Hypotension / Q000139:chemically induced* / Q000453:epidemiology / Q000209:etiology; D015994:Incidence; D007384:Intermittent Positive-Pressure Breathing; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D015431:Weight Loss; D055815:Young Adult