Intraoperative blood pressure has been suggested as a key factor for safe pediatric anesthesia. However, there is not much insight into factors that discriminate between children with low and normal pre‐incision blood pressure. Our aim was to explore whether children who have a low blood pressure during anesthesia are different than those with normal blood pressure. The focus of the present study was on the pre‐incision period.
This retrospective study included pediatric patients undergoing anesthesia for non‐cardiac surgery at a tertiary pediatric university hospital, between 2012 and 2016. We analyzed the association between pre‐incision blood pressure and patient‐ and anesthesia characteristics, comparing low with normal pre‐incision blood pressure. This association was further explored with a multivariable linear regression.
In total, 20 962 anesthetic cases were included. Pre‐incision blood pressure was associated with age (beta −0.04 SD per year), gender (female −0.11), previous surgery (−0.15), preoperative blood pressure (+0.01 per mm Hg), epilepsy (0.12), bronchial hyperactivity (−0.18), emergency surgery (0.10), loco‐regional technique (−0.48), artificial airway device (supraglottic airway device instead of tube 0.07), and sevoflurane concentration (0.03 per sevoflurane %).
Children with low pre‐incision blood pressure do not differ on clinically relevant factors from children with normal blood pressure. Although the present explorative study shows that pre‐incision blood pressure is partly dependent on patient characteristics and partly dependent on anesthetic technique, other unmeasured variables might play a more important role.
Low blood pressure in anesthetized children before the surgical incision is not desirable. This retrospective study tried to find associated factors in a large pediatric surgical cohort. The findings from this analysis suggest that pre‐incision low blood pressure occurs in children with different characteristics and exposure factors. Concurrent regional anesthesia and intubation was the factor most strongly associated with low pre‐incision blood pressure.