Intraoperative Hypotonie: Bedeutung und Monitoring in der klinischen Praxis

Paul Frank; Christoph Ilies; René Schmidt; Berthold Bein

doi:10.1055/s-0042-107915

AINS - Anästhesiologie · Intensivmedizin · Notfallmedizin · Schmerztherapie, Inhaltsverzeichnis

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52(01): 29-44
DOI: 10.1055/s-0042-107915

Topthema

Georg Thieme Verlag KG Stuttgart · New York

Intraoperative Hypotonie: Bedeutung und Monitoring in der klinischen Praxis

Paul Frank^*

,

Christoph Ilies^*

,

René Schmidt

,

Berthold Bein

Abstract

Zusammenfassung

Intraoperative Hypotonie ist im klinischen Alltag keine Seltenheit. Obwohl ein Zusammenhang mit erhöhter perioperativer Morbidität und Letalität zu bestehen scheint, wird sie oft zu spät oder gar nicht therapiert. Dabei gibt es eine Vielzahl an Prädiktoren und technischen Hilfsmitteln, um Risikopatienten zu identifizieren und das perioperative Management durch ein adäquates Monitoring und eine frühzeitige Therapie zu optimieren.

Abstract

Despite the high incidence of hypotension after anesthesia induction, awareness of the need to adequately and above all rapidily treat this condition is not always present in clinical practice.
There is strong evidence that even a short episode of perioperative hypotension can significantly increase morbidity and mortality.
Many risk factors for the occurrence of hypotension are known. Patients should be closely monitored and rapidly treated.
In patients at risk, the average arterial blood pressure should not exceed of 80 mmHg perioperatively.
Pre-existing hypovolemia enhances hypotension after anesthesia induction. Since many predictors are known, these should be applied and the volume status optimized before initiation of anesthesia.
Ultrasound procedures can be used to quickly assess critical circulatory conditions.
To predict hypotension after anesthesia, the "collapseability index" of the inferior vena cava is most likely to be used.
Even a less experienced user can judge the presence of severely restricted cardiac function. The RUSH protocol has a high sensitivity and specificity for differentiating different forms of shock.

Schlüsselwörter

Hypotonie - Monitoring - Prädiktion - intraoperativ - Diagnostik - Sonografie

Key words

hypotension - monitoring - prediction - intraoperative - diagnostics - sonography

Volltext

Referenzen

Literatur
1 Bijker JB, van Klei WA, Kappen TH et al. Incidence of intraoperative hypotension as a function of the chosen definition: literature definitions applied to a retrospective cohort using automated data collection. Anesthesiology 2007; 107: 213-220
2 Butwick AJ, Columb MO, Carvalho B. Preventing spinal hypotension during Caesarean delivery: what is the latest?. Br J Anaesth 2015; 114: 183-186
3 Ilies C, Kiskalt H, Siedenhans D et al. Detection of hypotension during Caesarean section with continuous non-invasive arterial pressure device or intermittent oscillometric arterial pressure measurement. Br J Anaesth 2012; 109: 413-419
4 Walsh M, Devereaux PJ, Garg AX et al. Relationship between intraoperative mean arterial pressure and clinical outcomes after noncardiac surgery: toward an empirical definition of hypotension. Anesthesiology 2013; 119: 507-515
5 Bijker JB, Persoon S, Peelen LM et al. Intraoperative hypotension and perioperative ischemic stroke after general surgery: a nested case-control study. Anesthesiology 2012; 116: 658-664
6 van Waes JA, van Klei WA, Wijeysundera DN et al. Association between intraoperative hypotension and myocardial injury after vascular surgery. Anesthesiology 2016; 124: 35-44
7 Monk TG, Bronsert MR, Henderson WG et al. Association between intraoperative hypotension and hypertension and 30-day postoperative mortality in noncardiac surgery. Anesthesiology 2015; 123: 307-319
8 Monk TG, Saini V, Weldon BC et al. Anesthetic management and one-year mortality after noncardiac surgery. Anesth Analg 2005; 100: 4-10
9 Bijker JB, van Klei WA, Vergouwe Y et al. Intraoperative hypotension and 1-year mortality after noncardiac surgery. Anesthesiology 2009; 111: 1217-1226
10 Wickham A, Highton D, Martin D. The Pan London Perioperative Audit and Research Network (PLAN). Care of elderly patients: a prospective audit of the prevalence of hypotension and the use of BIS intraoperatively in 25 hospitals in London. Perioper Med (Lond) 2016; 5: 12
11 Cheung CC, Martyn A, Campbell N et al. Predictors of intraoperative hypotension and bradycardia. Am J Med 2015; 128: 532-538
12 Jo YY, Jung WS, Kim HS et al. Prediction of hypotension in the beach chair position during shoulder arthroscopy using pre-operative hemodynamic variables. J Clin Monit Comput 2014; 28: 173-178
13 Salazar D, Sears BW, Andre J et al. Cerebral desaturation during shoulder arthroscopy: a prospective observational study. Clin Orthop Relat Res 2013; 471: 4027-4034
14 Hug Jr. CC, McLeskey CH, Nahrwold ML et al. Hemodynamic effects of propofol: data from over 25,000 patients. Anesth Analg 1993; 77: S21-S29
15 Phillips AT, Deiner S, Mo Lin H et al. Propofol use in the elderly population: prevalence of overdose and association with 30-day mortality. Clin Ther 2015; 37: 2676-2685
16 Lonjaret L, Lairez O, Minville V et al. Optimal perioperative management of arterial blood pressure. Integr Blood Press Control 2014; 7: 49-59
17 Kheterpal S, Avidan MS. “Triple low”: murderer, mediator, or mirror. Anesthesiology 2012; 116: 1176-1178
18 Willingham MD, Karren E, Shanks AM et al. Concurrence of intraoperative hypotension, low minimum alveolar concentration, and low bispectral index is associated with postoperative death. Anesthesiology 2015; 123: 775-785
19 Brenck F, Hartmann B, Katzer C et al. Hypotension after spinal anesthesia for cesarean section: identification of risk factors using an anesthesia information management system. J Clin Monit Comput 2009; 23: 85-92
20 Frolich MA, Caton D. Baseline heart rate may predict hypotension after spinal anesthesia in prehydrated obstetrical patients. Can J Anaesth 2002; 49: 185-189
21 Veering BT. Hemodynamic effects of central neural blockade in elderly patients. Can J Anaesth 2006; 53: 117-121
22 Simon MJ, Veering BT, Stienstra R et al. The effects of age on neural blockade and hemodynamic changes after epidural anesthesia with ropivacaine. Anesth Analg 2002; 94: 1325-1330
23 James MA, Potter JF. Orthostatic blood pressure changes and arterial baroreflex sensitivity in elderly subjects. Age Ageing 1999; 28: 522-530
24 Kim SH, Lilot M, Sidhu KS et al. Accuracy and precision of continuous noninvasive arterial pressure monitoring compared with invasive arterial pressure: a systematic review and meta-analysis. Anesthesiology 2014; 120: 1080-1097
25 Smolle KH, Schmid M, Prettenthaler H et al. The accuracy of the CNAP(R) device compared with invasive radial artery measurements for providing continuous noninvasive arterial blood pressure readings at a medical intensive care unit: a method-comparison study. Anesth Analg 2015; 121: 1508-1516
26 Martina JR, Westerhof BE, van Goudoever J et al. Noninvasive continuous arterial blood pressure monitoring with Nexfin(R). Anesthesiology 2012; 116: 1092-1103
27 Meidert AS, Huber W, Muller JN et al. Radial artery applanation tonometry for continuous non-invasive arterial pressure monitoring in intensive care unit patients: comparison with invasively assessed radial arterial pressure. Br J Anaesth 2014; 112: 521-528
28 Ilies C, Grudev G, Hedderich J et al. Comparison of a continuous noninvasive arterial pressure device with invasive measurements in cardiovascular postsurgical intensive care patients: a prospective observational study. Eur J Anaesthesiol 2015; 32: 20-28
29 Pinsky MR. Functional haemodynamic monitoring. Curr Opin Crit Care 2014; 20: 288-293
30 Teboul JL, Monnet X. Prediction of volume responsiveness in critically ill patients with spontaneous breathing activity. Curr Opin Crit Care 2008; 14: 334-339
31 MacDonald N, Ahmad T, Mohr O et al. Dynamic preload markers to predict fluid responsiveness during and after major gastrointestinal surgery: an observational substudy of the OPTIMISE trial. Br J Anaesth 2015; 114: 598-604
32 Renner J, Broch O, Bein B. Perioperatives Flüssigkeitsmanagement – Abschätzung des Volumenstatus. Anasthesiol Intensivmed Notfallmed Schmerzther 2012; 47: 470-479
33 Boyd JH, Sirounis D. Assessment of adequacy of volume resuscitation. Curr Opin Crit Care 2016; 22: 424-427
34 Preau S, Saulnier F, Dewavrin F et al. Passive leg raising is predictive of fluid responsiveness in spontaneously breathing patients with severe sepsis or acute pancreatitis. Crit Care Med 2010; 38: 819-825
35 Marx G, Schindler AW, Mosch C et al. Intravascular volume therapy in adults: Guidelines from the Association of the Scientific Medical Societies in Germany. Eur J Anaesthesiol 2016; 33: 488-521
36 Hanss R, Bein B, Ledowski T et al. Heart rate variability predicts severe hypotension after spinal anesthesia for elective cesarean delivery. Anesthesiology 2005; 102: 1086-1093
37 Hanss R, Bein B, Weseloh H et al. Heart rate variability predicts severe hypotension after spinal anesthesia. Anesthesiology 2006; 104: 537-545
38 Toyama S, Kakumoto M, Morioka M et al. Perfusion index derived from a pulse oximeter can predict the incidence of hypotension during spinal anaesthesia for Caesarean delivery. Br J Anaesth 2013; 111: 235-241
39 Klijn E, Groeneveld AB, van Genderen ME et al. Peripheral perfusion index predicts hypotension during fluid withdrawal by continuous veno-venous hemofiltration in critically ill patients. Blood Purif 2015; 40: 92-98
40 Tsuchiya M, Yamada T, Asada A. Pleth variability index predicts hypotension during anesthesia induction. Acta Anaesthesiol Scand 2010; 54: 596-602
41 Yin JY, Ho KM. Use of plethysmographic variability index derived from the Massimo(®) pulse oximeter to predict fluid or preload responsiveness: a systematic review and meta-analysis. Anaesthesia 2012; 67: 777-783
42 Sun S, Huang SQ. Role of pleth variability index for predicting hypotension after spinal anesthesia for cesarean section. Int J Obstet Anesth 2014; 23: 324-329
43 Sun S, Liu NH, Huang SQ. Role of cerebral oxygenation for prediction of hypotension after spinal anesthesia for caesarean section. J Clin Monit Comput 2016; 30: 417-421
44 Kircher BJ, Himelman RB, Schiller NB. Noninvasive estimation of right atrial pressure from the inspiratory collapse of the inferior vena cava. Am J Cardiol 1990; 66: 493-496
45 Martin S. Doppler echocardiography in non-invasive evaluation of central venous pressure. Rev Port Cardiol 2002; 21: 135-138
46 Bendjelid K, Romand JA, Walder B et al. Correlation between measured inferior vena cava diameter and right atrial pressure depends on the echocardiographic method used in patients who are mechanically ventilated. J Am Soc Echocardiogr 2002; 15: 944-949
47 De Lorenzo RA, Morris MJ, Williams JB et al. Does a simple bedside sonographic measurement of the inferior vena cava correlate to central venous pressure?. J Emerg Med 2012; 42: 429-436
48 Zahn J, Chritchley LA. Inferior vena cava ultrasonography before general anesthesia can predict hypotension after Induction. Anesthesiology 2016; 124: 580-589
49 Perera P, Mailhot T, Riley D et al. The RUSH exam: rapid ultrasound in shock in the evaluation of the critically lll. Emerg Med Clin North Am 2010; 28: 29-56
50 Perera P, Mailhot T, Riley D et al. The RUSH exam 2012: rapid ultrasound in shock in the evaluation of the critically ill patient. Ultrasound Clin 2012; 7: 255-278
51 Ghane MR, Gharib M, Ebrahimi A et al. Accuracy of early rapid ultrasound in shock (RUSH) examination performed by emergency physician for diagnosis of shock etiology in critically ill patients. J Emerg Trauma Shock 2015; 8: 5-10
52 Bagheri-Hariri S, Yekesadat M, Farahmand S et al. The impact of using RUSH protocol for diagnosing the type of unknown shock in the emergency department. Emerg Radiol 2015; 22: 517-520
53 Brady K, Hogue CW. Intraoperative hypotension and patient outcome: does “one size fit all?”. Anesthesiology 2013; 119: 495-497
54 London MJ. Intraoperative mean blood pressure and outcome: is 80 (mmHg) the “New” 60?. Anesthesiology 2016; 124: 4-6
55 Schnider TW, Minto CF, Shafer SL et al. The influence of age on propofol pharmacodynamics. Anesthesiology 1999; 90: 1502-1516
56 Gurses E, Sungurtekin H, Tomatir E et al. Assessing propofol induction of anesthesia dose using bispectral index analysis. Anesth Analg 2004; 98: 128-131
57 Macquaire V, Cantraine F, Schmartz D et al. Target-controlled infusion of propofol induction with or without plasma concentration constraint in high-risk adult patients undergoing cardiac surgery. Acta Anaesthesiol Scand 2002; 46: 1010-1016
58 Kertai MD, Palanca BJ, Pal N et al. Bispectral index monitoring, duration of bispectral index below 45, patient risk factors, and intermediate-term mortality after noncardiac surgery in the B-Unaware Trial. Anesthesiology 2011; 114: 545-556
59 Holm JA, Frederiksen CA, Juhl-Olsen P et al. Perioperative use of focus assessed transthoracic echocardiography (FATE). Anesth Analg 2012; 115: 1029-1032