Table 1
Patients’ characteristics and types of anesthesia and surgery.
| PATIENTS, N | 4776 |
|---|---|
| Age, years (median) | 41 (32–56) |
| ≤40 | 2358 (49.4) |
| 40> and ≤65 | 1778 (37.2) |
| >65 | 640 (13.4) |
| Sex, male, n (%) | 1891 (39.6) |
| ASA score, (median) | 1 (1–2) |
| ASA≥2 | 2120 (44.4) |
| Comorbidities, n (%) | |
| Hypertension | 523 (11.0) |
| Diabetes mellitus | 308 (6.4) |
| Heart failure | 54 (1.1) |
| Type of surgery, n (%) | |
| General surgery | 1267 (26.5) |
| Gynecology and obstetrics | 861 (18.0) |
| Orthopedic | 785 (16.4) |
| Neurosurgery | 554 (11.6) |
| ENT surgery | 502 (10.5) |
| Urology | 389 (8.2) |
| Plastic surgery | 253 (5.3) |
| Chest surgery | 133 (2.8) |
| Eye surgery | 32 (0.6) |
| Major surgery, n (%) | 1230 (25.8) |
[i] ASA, American Society of Anesthesiology; ENT, ear, nose, and throat.
Table 2
Comparisons between intraoperative normotensive and hypotensive patients.
| NORMOTENSIVE PATIENTS (N = 3719) | IOH | |||
|---|---|---|---|---|
| TOTAL (N = 1057) | pIOH (N = 807) | mIOH (N = 250) | ||
| DEMOGRAPHIC DATA AND COMORBIDITIES, N (%) | ||||
| Age | ||||
| ≤40 | 1869 (50.2) | 489 (46.3) | 386 (47.8) | 103 (41.2)ΩΩ |
| 40> and ≤65 | 1368 (36.8) | 410 (38.8) | 308 (38.2) | 102 (40.8) |
| >65 | 482 (13.0) | 158 (14.9) | 113(14.0) | 45 (18.0)ΩΩ |
| ASA≥2 | 1539 (41.4) | 581 (55.0)*** | 404 (50.1)### | 177 (70.8)ΩΩΩ, ßßß |
| Male | 1457 (39.2) | 434 (41.1) | 337 (41.8) | 97 (38.8) |
| Hypertension | 397 (10.7) | 126 (11.9) | 95 (11.8) | 31 (12.4) |
| Diabetes mellitus | 238 (6.4) | 70 (6.6) | 49 (6.1) | 21 (8.4) |
| Congestive heart failure | 42 (1.1) | 12 (1.1) | 11 (1.4) | 1 (0.4) |
| INTRAOPERATIVE PERIOD, N (%) | ||||
| MAP, mmHg | ||||
| Pre-Anesthesia induction | 91 (83-100) | 100 (92-110)*** | 102 (95-110)### | 93 (85-102)Ω, ßßß |
| Post-Anesthesia induction | 76 (69-85) | 66 (60-72)*** | 65 (60-71)### | 68 (61-77)ΩΩΩ, ßßß |
| Major surgery | 976 (26.2) | 254 (24.0) | 175 (21.7)## | 79 (31.6)ßß |
| Ephedrin usage | 396 (10.6) | 415 (39.3)*** | 181 (22.4)### | 234 (93.6)ΩΩΩ, ßßß |
| Unplanned transfusion | 6 (0.2) | 4 (0.4) | 0 (0.0) | 4 (1.6)ΩΩ, ßß |
| Unexpected bleeding | 15 (0.4) | 9 (0.9) | 1 (0.1) | 8 (3.2)ΩΩΩ, ßßß |
| Bradycardia | 47 (1.3) | 39 (3.7)*** | 22 (2.7)## | 17 (6.8)ΩΩΩ, ßß |
| Tachycardia | 31 (0.8) | 15 (1.4) | 9 (1.1) | 6 (2.4)Ω |
| Hypothermia | 43 (1.2) | 29 (2.7)*** | 13 (1.6) | 16 (6.4)ΩΩΩ, ßßß |
| POSTOPERATIVE COMPLICATIONS, N (%) | ||||
| Longer PACU duration | 1896 (51.0) | 550 (52.0) | 402 (49.8) | 148 (59.2)Ω, ßß |
| Postoperative SpO2<%90 | 51 (1.4) | 15 (1.4) | 11 (1.4) | 4 (1.6) |
| Need for O2 therapy | 77 (2.1) | 27 (2.6) | 16 (2.0) | 11 (4.4)Ω, ß |
| Arrhythmia | 24 (0.6) | 9 (0.9) | 7 (0.9) | 2 (0.8) |
| Bradycardia or Tachycardia | 32 (0.9) | 17 (1.6)* | 13 (1.6) | 4 (1.6) |
| Nausea | 193 (5.2) | 51 (4.8) | 34 (4.2) | 17 (6.8) |
| Vomiting | 57 (1.5) | 20 (1.9) | 12 (1.5) | 8 (3.2)Ω |
| Unplanned ICU admission | 2 (0.1) | 6 (0.6)** | 4 (0.5)# | 2 (0.8)Ω |
[i] ASA, American Society of Anesthesiology; mIOH, maintenance intraoperative hypotension; O2, Oxygen; PACU, Post Anesthesia Care Unit; pIOH, Post-induction hypotension.
*; comparison between normotensive and total hypotensive patients, #; comparison between normotensive and pIOH patients, Ω; comparison between normotensive and mIOH patients, β; comparison between pIOH and mIOH patients.
* and # and Ω and ß, p; 0.05–0.01.
** and ## and ΩΩ and ßß, p; 0.01–0.001.
*** and ### and ΩΩΩ and ßßß, p < 0.001.
Table 3
Comparisons between patients with ephedrine (–) and (+) in intraoperative period.
| EPHEDRINE (–) (N = 3965) | EPHEDRINE (+) (N = 811) | P | |
|---|---|---|---|
| DEMOGRAPHIC DATA AND COMORBIDITIES, N (%) | |||
| Age | <0.001 | ||
| ≤40 | 2016 (50.9) | 342 (42.2) | |
| 40> and ≤65 | 1448 (36.5) | 330 (40.7) | |
| >65 | 501(12.6) | 136 (17.1) | |
| ASA≥2 | 1594 (40.2) | 526 (64.9) | <0.001 |
| Male | 1555 (39.2) | 336 (41.4) | 0.241 |
| Hypertension | 416 (10.5) | 107 (13.2) | 0.025 |
| Diabetes mellitus | 247 (6.2) | 61 (7.5) | 0.172 |
| Congestive heart failure | 44 (1.1) | 10 (1.2) | 0.762 |
| INTRAOPERATIVE PERIOD, N (%) | |||
| Major surgery | 997 (25.1) | 233 (28.7) | 0.033 |
| pIOH | 629 (15.9) | 263 (32.4) | <0.001 |
| mIOH and/or pIOH | 16 (0.4) | 234 (28.9) | <0.001 |
| Bradycardia | 48 (1.2) | 38 (4.7) | <0.001 |
| Tachycardia | 33 (0.8) | 13 (1.6) | 0.041 |
| Unplanned transfusion | 6 (0.2) | 4 (0.5) | 0.074 |
| Unexpected bleeding | 12 (0.3) | 12 (1.5) | <0.001 |
| Hypotermia at the end of the surgery | 39 (1.0) | 33 (4.1) | <0.001 |
| POSTOPERATIVE COMPLICATIONS, N (%) | |||
| Duration of PACU >30min | 1973 (49.8) | 473 (58.3) | <0.001 |
| Postoperative SpO2<%90 | 50 (1.3) | 16 (2.0) | 0.114 |
| Need for O2 therapy | 70 (1.8) | 34 (4.2) | <0.001 |
| Arrhythmia | 28 (0.7) | 5 (0.6) | 0.779 |
| Bradycardia or Tachycardia | 33 (0.8) | 16 (2.0) | 0.003 |
| Nausea | 198 (5.0) | 46 (5.7) | 0.424 |
| Vomiting | 61 (1.5) | 16 (2.0) | 0.371 |
| Unplanned ICU admission | 4 (0.1) | 4 (0.5) | 0.033 |
[i] ASA, American Society of Anesthesiology; mIOH, maintenance intraoperative hypotension; O2, Oxygen; PACU, Post Anesthesia Care Unit; SpO2, oxygen saturation; pIOH, Post-induction hypotension.
Table 4
Factors affecting the length of stay in the PACU.
| SHORT PACU DURATION (N = 2330) | LONG PACU DURATION (N = 2446) | P | |
|---|---|---|---|
| PREOPERATIVE PERIOD, N (%) | |||
| Age | 0.618 | ||
| ≤40 | 1193 (48.8) | 1165 (50.0) | |
| 40> and ≤65 | 916 (37.4) | 862 (37.0) | |
| >65 | 337 (13.8) | 385 (15.7) | |
| ASA≥2 | 985 (42.3) | 1135 (46.4) | 0.004 |
| Male | 952 (40.9) | 939 (38.4) | 0.081 |
| Hypertension | 255 (10.9) | 268 (11.0) | 0.989 |
| Diabetes mellitus | 149 (6.4) | 159 (6.5) | 0.882 |
| Congestive heart failure | 26 (1.1) | 28 (1.1) | 0.925 |
| Preoperative SpO2<%95 | 41 (1.8) | 58 (2.4) | 0.138 |
| INTRAOPERATIVE PERIOD, N (%) | |||
| Major surgery, n (%) | 560 (24.0) | 670 (27.4) | 0.008 |
| pIOH | 445 (19.1) | 447 (18.3) | 0.465 |
| mIOH | 102 (4.4) | 148 (6.1) | 0.009 |
| Bradycardia | 45 (1.9) | 41 (1.7) | 0.507 |
| Tachycardia | 17 (0.7) | 29 (1.2) | 0.107 |
| Ephedrine usage | 338 (14.5) | 473 (19.3) | <0.001 |
| Unexpected bleeding | 6 (0.3) | 18 (0.7) | 0.019 |
| Unscheduled transfusion | 1 (0.1) | 9 (0.4) | 0.013 |
| Hypotermia | 20 (0.9) | 52 (2.1) | <0.001 |
| PACU PERIOD, N (%) | |||
| Nausea | 49 (2.1) | 195 (8.0) | <0.001 |
| Vomiting | 12 (0.5) | 65 (2.7) | <0.001 |
| Need for O2 therapy (>4L min-1) | 42 (1.8) | 62 (2.5) | 0.083 |
| Need for additional analgesics | 90 (3.9) | 731 (29.9) | <0.001 |
[i] ASA, American Society of Anesthesiology; mIOH, maintenance intraoperative hypotension; O2, Oxygen; PACU, Post Anesthesia Care Unit; SpO2, oxygen saturation; pIOH, Post-induction hypotension.
Table 5
Multivariate logistic regression model for the likelihood of the PACU duration>30 min.
| OR (CI 95%) | P | |
|---|---|---|
| PREOPERATIVE PERIOD | ||
| ASA≥2 | 1.1 (0.9–1.2) | 0.153 |
| INTRAOPERATIVE PERIOD | ||
| Ephedrine usage | 1.3 (1.1–1.6) | 0.003 |
| Hypothermia at the end of the surgery | 2.1 (1.2–3.6) | 0.010 |
| Unexpected bleeding | 2.4 (0.9–6.4) | 0.082 |
| Major surgery | 1.1 (0.9–1.3) | 0.102 |
| Unplanned transfusion | 5.7 (0.7–48.2) | 0.113 |
| mIOH | 0.9 (0.7–1.4) | 0.897 |
| PACU PERIOD | ||
| Need for additional analgesics | 10.3 (8.2-13.0) | <0.001 |
| Nausea | 3.1 (2.1-4.4) | <0.001 |
| Vomiting | 2.1 (1.1-4.2) | 0.037 |
[i] ASA, American Society of Anesthesiology; mIOH, maintenance intraoperative hypotension; O2, Oxygen; PACU, Post Anesthesia Care Unit; SpO2, oxygen saturation; pIOH, Post-induction hypotension.