Etomidate-induced hypotension: a pathophysiological approach using arterial elastance - 11/01/19

Doi : 10.1016/j.accpm.2018.12.006

Osama Abou Arab ^1,^2,^⁎ , Marc Olivier Fischer ³, Alexis Carpentier ⁴, Christophe Beyls ⁵, Pierre Huette ⁶, Abdel Hchikat ⁷, Amar Benammar ⁸, Beatris Labont ⁹, Yazine Mahjoub ^10,¹¹, Stéphane Bar ^12,¹¹, Pierre-Grégoire Guinot ¹³, Emmanuel Lorne ^14,¹¹
¹ Medical doctor, Department of Anaesthesiology and Critical Care Medicine, Amiens Picardy University Hospital, Amiens, 80054, France
² MP3CV, EA7517, CURS, Jules Verne University of Picardie, 80054 Amiens, France
³ Medical doctor, Department of Anaesthesiology and Critical Care Medicine, Amiens Picardy University Hospital, Amiens, 80054, France
⁴ Medical doctor, Department of Anaesthesiology and Critical Care Medicine, Amiens Picardy University Hospital, Amiens, 80054, France
⁵ Medical doctor, Department of Anaesthesiology and Critical Care Medicine, Amiens Picardy University Hospital, Amiens, 80054, France
⁶ Medical doctor, Department of Anaesthesiology and Critical Care Medicine, CHU de Caen, Anaesthesiology. Caen University Hospital. Caen, 14000, France
⁷ Medical doctor, Department of Anaesthesiology and Critical Care Medicine, CHU de Caen, Anaesthesiology. Caen University Hospital. Caen, 14000, France
⁸ Medical doctor, Department of Anaesthesiology and Critical Care Medicine, Amiens Picardy University Hospital, Amiens, 80054, France
⁹ Medical doctor, Department of Anaesthesiology and Critical Care Medicine, Amiens Picardy University Hospital, Amiens, 80054, France
¹⁰ Professor, Department of Anaesthesiology and Critical Care Medicine, Dijon University Hospital, Dijon, 14033 France
¹¹ SSPC (Simplification des Soins des Patients Complexes) - Clinical Research Unit, University of Picardie Jules Verne, 80054 Amiens Cedex 01, France
¹² Medical doctor, Department of Anaesthesiology and Critical Care Medicine, Amiens Picardy University Hospital, Amiens, 80054, France
¹³ Professor, Department of Anaesthesiology and Critical Care Medicine, Dijon University Hospital, Dijon, 14033 France
¹⁴ Professor, Department of Anaesthesiology and Critical Care Medicine, Amiens Picardy University Hospital, Amiens, 80054, France

^⁎Correspondence to: Department of Anaesthesiology and Critical Care Medicine, Amiens University Hospital, Place Victor Pauchet, Amiens, 80054, FranceDepartment of Anaesthesiology and Critical Care MedicineAmiens University HospitalPlace Victor PauchetAmiens80054France

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Abstract

Introduction: Anaesthesia frequently induces hypotension. Several recent studies have analysed arterial elastance (Ea) in order to describe clinical variations of mean arterial pressure (MAP). The objective of the study was to assess Ea to explain MAP variation following etomidate induction.

Methods: We conducted a prospective single-centre study. Inclusion criteria were patients undergoing elective cardiac surgery with invasive blood pressure monitoring. Ea was expressed as Pes/SV (Pes: end systolic pressure, SV: stroke volume). Cardiac index (CI), peripheral vascular resistance (PVR) and arterial compliance (C) was compared before and 2 minutes after etomidate induction. Arterial hypotension was defined as a decrease greater than 15% of the baseline MAP.

Results: Of the 45 patients included, 24 (53%) had a preserved MAP and 21 (47%) had an etomidate-induced hypotension. Ea was similar before induction and decreased in the decreased MAP group 2 minutes after induction (2.0 mmHg.ml-1 [1.7-2.4] vs 1.4 mmHg.ml-1 [0.9-1.9]; p = 0.001). Arterial compliance (C) increased in the decreased MAP group 2 minutes after induction (0.8 ml. mmHg-1 [0.6-1.0] vs 0.5 ml. mmHg-1 [0.4-0.6], p < 0.0001). No significant change in CI or PVR was observed between patients with or without etomidate-induced hypotension.

Conclusion: Etomidate-induced hypotension was associated to a decrease in Ea. Ea variations can mainly be explained by induced changes in arterial compliance.

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Keywords : arterial elastance, anaesthesia, Windkessel, arterial hypotension