Prediction of heparin induced hypotension during cardiothoracic surgery: A retrospective observational study

Abstract

Background: High-dose heparin occasionally causes severe hypotension during cardiothoracic surgery. Being able to predict the severity of the decrease in blood pressure prior to administration of heparin would improve hemodynamic and anesthetic management. The aim of this study was to investigate the predictors of heparininduced hypotension and the effects of high-dose heparin on various hemodynamic and physiologic parameters.
Methodology: The records of adult patients who underwent elective cardiothoracic surgery at University of Yamanashi Hospital between January 2016 and December 2017 were retrospectively reviewed. Single and multiple linear regression analyses were conducted to identify the predictors of heparin-induced hypotension.
Results: High baseline systemic vascular resistance index (SVRI) and non-use of preoperative antihypertensive medication were significant predictors of heparininduced hypotension with a following regression equation: Percent change in mean arterial pressure = 17.273 + 0.00457 × (baseline SVRI) - 14.043 × (antihypertensive medication), where antihypertensive medication is coded as 0 = no antihypertensive drug and 1 = one or more antihypertensive drug(s), F = 7.80, the multiple correlation coefficient is 0.68645, and R adjusted for degrees of freedom is 0.41078.
Conclusion: The baseline SVRI and non-use of preoperative antihypertensive medication are significant predictors of the severity of heparin-induced hypotension.
Abbreviations: MAP - Mean arterial blood pressure; CVP - central venous pressure; PAP - pulmonary arterial pressure; SVRI - systemic vascular resistance index; BMI: body mass index; ASA-PS: American Society of Anesthesiologists physical status classification; DM: diabetes mellitus; eGFR: estimated glomerular filtration rate; LVEF: left ventricular ejection fraction; EDVI: end-diastolic volume index; CI: cardiac index; SvO2: mixed venous oxygen saturation; LVEF: left ventricular ejection fraction; HR: heart rate.
Preregistration: The study was approved by the institutional review board of University of Yamanashi (study H30036, registered May 28, 2018).
Citation: Kotoda M, Ishiyama T, Nakajima H, Matsukawa T. Prediction of heparin induced hypotension during cardiothoracic surgery: A retrospective observational study. Anaesth pain & intensiv care 2019;23(2):145-150