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Clinical Research
Cardiothoracic and Vascular Anesthesia
Anesthesia and Pain Medicine 2013;8(2):104-111.
Published online April 30, 2013.
Predictability of passive leg raising test on anesthesia-induced hypotension in patients undergoing cardiac surgery
Hyun Joo Kim, Yoo Sun Jung, Jun Hyun Kim, Jae Hyon Bahk, Nam Su Gil, Young Jin Lim, Yunseok Jeon
1Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea. jeonyunseok@gmail.com
2Department of Anesthesiology and Pain Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea.
3Department of Anesthesiology and Pain Medicine, Boramae City Hospital, Seoul, Korea.
Abstract
BACKGROUND
Hypotension often occurs after induction of general anesthesia. Although preload status has been considered as an important factor for the occurrence of this hypotension, there have been inconsistent results on this topic. The dynamic preload parameters have not been studied as a predictor of hypotension, and therefore we hypothesized that the passive leg raising (PLR) test, a dynamic preload parameter, could predict anesthesia-induced hypotension and conducted a prospective clinical study.
METHODS
In 40 patients undergoing elective cardiac surgery, mean arterial pressure (MAP), stroke volume variation, stroke volume (SV) and cardiac index (CI) were measured using arterial line and FloTrac(TM)/Vigileo(TM) system before, during and after PLR test, respectively. Occurrence of anesthesia-induced hypotension was recorded. The ability of PLR test to predict hypotension was evaluated by receiver operating characteristic (ROC) curve analysis.
RESULTS
The incidence of hypotension was 90%, which includes 12.5% of refractory hypotension. Changes in MAP and CI induced by PLR test predicted hypotension (area under ROC curves: 0.722 and 0.788, respectively). Changes in SV and CI induced by PLR test predicted refractory hypotension (area under ROC curves: 0.863 and 0.789, respectively).
CONCLUSIONS
Our results suggest that PLR test can predict hypotension and refractory hypotension occurring after induction of anesthesia in patients undergoing cardiac surgery.
Key Words: Blood pressure, Hypotension, Passive leg raising test, Positioning
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