Prediction of hypotension during the alveolar recruitment maneuver in spine surgery: a prospective observational study

Ji Young Min; Hyun Jae Chang; Sung Jun Kim; Seung Hee Cha; Joon Pyo Jeon; Chang Jae Kim; Mee Young Chung

doi:10.1186/s40001-023-01031-8

Prediction of hypotension during the alveolar recruitment maneuver in spine surgery: a prospective observational study

Eur J Med Res. 2023 Feb 3;28(1):64. doi: 10.1186/s40001-023-01031-8.

Authors

Ji Young Min¹, Hyun Jae Chang¹, Sung Jun Kim¹, Seung Hee Cha², Joon Pyo Jeon¹, Chang Jae Kim¹, Mee Young Chung³

Affiliations

¹ Department of Anesthesiology and Pain Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 1021 Tongil-ro, Eunpyeong-gu, Seoul, 03312, Republic of Korea.
² Department of Anesthesiology and Pain Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 10, 63-ro, Yeongdeungpo-gu, Seoul, 07345, Republic of Korea.
³ Department of Anesthesiology and Pain Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 1021 Tongil-ro, Eunpyeong-gu, Seoul, 03312, Republic of Korea. jhjs0806@catholic.ac.kr.

Abstract

Background: Atelectasis can occur in many clinical practices. One way to prevent this complication is through the alveolar recruitment maneuver (ARM). However, hemodynamic compromise can accompany ARM. This study aims to predict ARM-induced hypotension using a non-invasive method.

Methods: 94 American Society of Anesthesiologists physical status I-II patients aged 19 to 75 with scheduled spinal surgery were enrolled. After anesthesia, we performed a stepwise ARM. Data on perfusion index, mean arterial pressure, heart rate, pleth variability index, cardiac index, and stroke volume variation was collected before induction of anesthesia (T0), just before ARM (T1), at the start of ARM (T2), 0.5 min (T3), 1 min (T4), 1.5 min (T5, end of ARM), and 2 min after the beginning of ARM (T6). Hypotension was defined as when the mean arterial pressure at T5 decreased by 20% or more compared to the baseline. The primary endpoint is that the perfusion index measuring before induction of anesthesia, which reflects the patients' own vascular tone, was correlated with hypotension during ARM.

Results: Seventy-five patients (79.8%) patients developed hypotension during ARM. The pre-induction persufion index (Pi) (95% confidence interval) was 1.7(1.4-3.1) in the non-hypotension group and 3.4(2.4-3.9) in the hypotension group. (p < 0.004) The hypotension group showed considerably higher Pi than the non-hypotension group before induction. The decrease of Pi (%) [IQR] in the non-hypotensive group (52.8% [33.3-74.7]) was more significant than in the hypotensive group. (36% [17.6-53.7]) (p < 0.05) The area under the receiver operating characteristic curve of Pi for predicting hypotension during ARM was 0.718 (95% CI 0.615-0.806; p = 0.004), and the threshold value of the Pi was 2.4.

Conclusion: A higher perfusion index value measuring before induction of anesthesia can be used to predict the development of hypotension during ARM. Prophylactic management of the following hypotension during ARM could be considered in high baseline Pi patients.

Keywords: Atelectasis; Hypotension; Perfusion index; Recruitment maneuver; Vascular resistance; Vasomotor tone.

Publication types

Observational Study

MeSH terms

Anesthesia, Spinal*
Heart Rate
Hemodynamics
Humans
Hypotension* / chemically induced
Prospective Studies