• J Neurosurg Anesthesiol · Apr 2020

    Predictive Factors for Hypotension Associated With Supine-to-Prone Positional Change in Patients Undergoing Spine Surgery.

    • Hyun-Kyu Yoon, Hyung-Chul Lee, Jaeyeon Chung, and Hee-Pyoung Park.
    • Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea.
    • J Neurosurg Anesthesiol. 2020 Apr 1; 32 (2): 140-146.

    BackgroundPositional change during general anesthesia can cause hypotension. The objective of this retrospective study was to determine predictive factors for hypotension associated with supine-to-prone positional change in spinal surgery patients.Materials And MethodsData on demographics, current medications, comorbidity, intraoperative mean arterial pressure (MAP), heart rate, pulse pressure variation, tidal volume, peak inspiratory pressure, and propofol and remifentanil effect-site concentrations were collected from 179 patients undergoing elective spine surgery. Hypotension associated with supine-to-prone positional change was defined as >20% reduction in MAP during positional change.ResultsHypotension associated with supine-to-prone positional change was observed in 16 (8.9%) patients. The median (interquartile range) effect-site concentration of remifentanil (5.3 [4.0 to 8.5] vs. 4.0 [3.1 to 4.0] ng/mL, P<0.001), MAP (95.0 [86.0 to 103.5] vs. 80.0 [70.0 to 94.0] mm Hg, P=0.014), peak inspiratory pressure (16.5 [15.0 to 18.5] vs. 15.0 [14.0 to 17.0] hPa, P=0.040) in the supine position, and pulse pressure variation in the prone position (12.0 [9.0 to 16.4] vs. 9.0 [7.0 to 12.0]%, P=0.019) were significantly higher in the hypotension group. In multivariate logistic regression analysis, the effect-site concentration of remifentanil (odd ratio [95% confidence interval], 2.12 [1.51-2.96], P<0.001), preoperative use of beta-blocker (7.64 [1.21-48.36], P=0.031), and MAP in the supine position (1.04 [1.00-1.07], P=0.033) were independent predictive factors for hypotension associated with supine-to-prone positional change.ConclusionsIncreased effect-site concentration of remifentanil, preoperative use of beta-blocker, and high MAP in the supine position were predictive factors for hypotension associated with supine-to-prone positional change in spinal surgery patients.

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