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Abstract：
BACKGROUND: Patients with severe aortic valve stenosis (AS) are particularly prone to developing hypotension during general anesthesia induction, which increases postoperative morbidity and mortality. Although the preventive effect of a single vasopressor dose on anesthesia-induced hypotension has been reported, the effects of continuous vasopressor infusion are unknown. This study aimed to assess the effect of noradrenaline (NAd) infusion on hemodynamic stability during general anesthesia induction in severe AS patients undergoing transcatheter aortic valve replacement (TAVR).
METHODS: This single-center, retrospective study included severe AS patients who underwent elective TAVR. Patients in the NAd group received a continuous prophylactic NAd infusion of 0.1 μg/kg/min from the time of anesthesia induction. The control group received inotropes and vasopressors as indicated by the occurrence of hypotension. The primary outcome was the lowest mean blood pressure (MBP) before the start of surgery.
RESULTS: The study included 68 patients in the NAd group and 113 in the control group. The lowest MBP before the start of surgery was significantly higher in the NAd group than in the control group (63 ± 15 vs 47 ± 13 mmHg, P < 0.01). MBP immediately before intubation was also significantly higher in the NAd group (75 ± 17 vs 57 ± 16 mmHg, P < 0.01). Differences in postoperative complications between the groups were negligible.
CONCLUSIONS: Continuous administration of NAd at 0.1 μg/kg/min in patients with severe AS might prevent hypotension during general anesthesia induction for TAVR.
METHODS: This single-center, retrospective study included severe AS patients who underwent elective TAVR. Patients in the NAd group received a continuous prophylactic NAd infusion of 0.1 μg/kg/min from the time of anesthesia induction. The control group received inotropes and vasopressors as indicated by the occurrence of hypotension. The primary outcome was the lowest mean blood pressure (MBP) before the start of surgery.
RESULTS: The study included 68 patients in the NAd group and 113 in the control group. The lowest MBP before the start of surgery was significantly higher in the NAd group than in the control group (63 ± 15 vs 47 ± 13 mmHg, P < 0.01). MBP immediately before intubation was also significantly higher in the NAd group (75 ± 17 vs 57 ± 16 mmHg, P < 0.01). Differences in postoperative complications between the groups were negligible.
CONCLUSIONS: Continuous administration of NAd at 0.1 μg/kg/min in patients with severe AS might prevent hypotension during general anesthesia induction for TAVR.
摘要：
背景：患有严重主动脉瓣狭窄（AS）的患者在全身麻醉诱导期间特别容易发生低血压，这增加了术后发病率和死亡率。尽管已经报道了单剂量升压药对麻醉诱导的低血压的预防作用，持续输注升压药的效果尚不清楚.本研究旨在评估经导管主动脉瓣置换术（TAVR）的严重AS患者全身麻醉诱导期间去甲肾上腺素（NAd）输注对血流动力学稳定性的影响。
方法：这种单中心，回顾性研究包括接受选择性TAVR的重度AS患者.NAd组的患者从麻醉诱导开始接受0.1μg/kg/min的持续预防性NAd输注。对照组根据低血压的发生情况接受肌力剂和血管加压药。主要结果是手术开始前的最低平均血压（MBP）。
结果：该研究包括NAd组68例患者和对照组113例患者。NAd组手术开始前最低MBP明显高于对照组(63±15vs47±13mmHg,P<0.01)。NAd组插管前的MBP也显着升高（75±17vs57±16mmHg，P<0.01)。两组之间术后并发症的差异可以忽略不计。
结论：重度AS患者持续给予0.1μg/kg/min的NAd可以预防TAVR全身麻醉诱导期间的低血压。
方法：这种单中心，回顾性研究包括接受选择性TAVR的重度AS患者.NAd组的患者从麻醉诱导开始接受0.1μg/kg/min的持续预防性NAd输注。对照组根据低血压的发生情况接受肌力剂和血管加压药。主要结果是手术开始前的最低平均血压（MBP）。
结果：该研究包括NAd组68例患者和对照组113例患者。NAd组手术开始前最低MBP明显高于对照组(63±15vs47±13mmHg,P<0.01)。NAd组插管前的MBP也显着升高（75±17vs57±16mmHg，P<0.01)。两组之间术后并发症的差异可以忽略不计。
结论：重度AS患者持续给予0.1μg/kg/min的NAd可以预防TAVR全身麻醉诱导期间的低血压。
