Postoperative Acute Kidney Injury Associated with Anesthesia Induction in Extremely Hypertensive Patients Undergoing Elective Non-Cardiac Surgery

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type:TOHO University Scholarly Publication

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Introduction: Some patients exhibit extreme hypertension before anesthetic induction. Although it is important to avoid hypotension during anesthesia to prevent major postoperative complications, it remains unknown how anesthetic hypotension should be managed in patients with hypertension. Therefore, we investigated the incidence of postoperative complications and their associations with low blood pressure during surgery in patients with a systolic blood pressure >200 mmHg before anesthetic induction. Methods: We assessed the incidence of postoperative acute kidney injury (AKI), myocardial infarction (MI), and ischemic stroke. For postoperative AKI, we investigated the duration, between intubation and surgery initiation, for which the patients' mean arterial pressure (MAP) was below the threshold, and the duration from surgery initiation to the end of anesthesia. Based on these analyses, factors considered to be clinically associated with postoperative AKI were extracted and subjected to multivariate logistic regression analysis. Results: In total, 274 patients were enrolled. Of these, 35 developed AKI and one experienced MI and ischemic stroke. The durations for which the MAP was <65, 70, and 75 mmHg between intubation and incision were significantly longer in the AKI group than in the non-AKI group (P < 0.01). Multivariate regression analysis revealed a statistically significant association between the duration of having a MAP <75 mmHg and postoperative AKI (adjusted odds ratio = 1.04, confidence interval=1.02-1.07, P < 0.001). Conclusions: In patients with extreme hypertension before anesthetic induction undergoing elective non-cardiac surgery, a MAP <75 mmHg between intubation and incision may be an independent risk factor for postoperative AKI.

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