Journal of clinical anesthesia · 2026
One-minute oscillometric vs. continuous arterial pressure monitoring for hypotension during anesthetic induction in low-risk patients: A randomized noninferiority trial.
СтатьяРандомизированное исследованиеМногоцентровое исследованиеEquivalence TrialСравнительное исследованиеНазвание и аннотация: Перевод пока не подготовлен
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Ju Jae-Woo, Kim Hyo Sung, Hong Hyunsook, Kim Heezoo, Lim Yeji, Kim Won Ho, Yoon Hyun-Kyu, Yoon Soo Bin, Lee Hyung-Chul, Jeon Yunseok, Sessler Daniel I, Kim Hyebin, Nam Karam, Seoul PeRioperative OUTcome research-2 (SPROUT-2) Investigators
Аннотация
STUDY OBJECTIVE: Consensus statements recommend pre-induction arterial catheterization to reduce hypotension during anesthetic induction. However, insertion is often deferred to reduce procedural delays and patient discomfort. We evaluated whether oscillometric monitoring at 1-min interval is noninferior to continuous arterial pressure monitoring on induction hypotension.
DESIGN: Bi-center randomized trial.
SETTING: Two tertiary university hospitals.
PATIENTS: Adults scheduled for noncardiac surgery requiring arterial catheterization.
INTERVENTION: Patients were randomized to unblinded continuous arterial pressure monitoring or to 1-min interval oscillometric monitoring with blinded intra-arterial pressures during induction.
MEASUREMENTS: The primary outcome was the area of mean arterial pressure (MAP) <65 mmHg during the initial 15 min of induction. Noninferiority was defined as a 10 mmHg∙min absolute increase in the observed median of the primary outcome compared with continuous monitoring, analyzed as a geometric mean ratio.
MAIN RESULTS: Among 253 analyzed patients (127 in the continuous monitoring group, 126 in the 1-min oscillometry group; 71% ASA physical status I or II), the median (interquartile range) area of MAP <65 mmHg was 3.0 (0 to 20) mmHg∙min in the continuous monitoring group and 3.3 (0 to 20) mmHg∙min in 1-min oscillometry group. The upper 97.5% confidence limit for the geometric mean ratio was 1.63, meeting the noninferiority margin of 3.50 (P < 0.001 for noninferiority). Vasopressor use was significantly greater in the continuous monitoring group (61% vs. 41%; P = 0.003), primarily driven by more frequent phenylephrine administration (24% vs. 7%; P = 0.001).
CONCLUSIONS: Induction hypotension was rare, and the area of MAP <65 mmHg was noninferior with oscillometric monitoring at 1-min interval versus continuous arterial pressure monitoring in relatively healthy patients. High-frequency oscillometric monitoring may be a safe and pragmatic alternative to pre-induction arterial catheterization.
DESIGN: Bi-center randomized trial.
SETTING: Two tertiary university hospitals.
PATIENTS: Adults scheduled for noncardiac surgery requiring arterial catheterization.
INTERVENTION: Patients were randomized to unblinded continuous arterial pressure monitoring or to 1-min interval oscillometric monitoring with blinded intra-arterial pressures during induction.
MEASUREMENTS: The primary outcome was the area of mean arterial pressure (MAP) <65 mmHg during the initial 15 min of induction. Noninferiority was defined as a 10 mmHg∙min absolute increase in the observed median of the primary outcome compared with continuous monitoring, analyzed as a geometric mean ratio.
MAIN RESULTS: Among 253 analyzed patients (127 in the continuous monitoring group, 126 in the 1-min oscillometry group; 71% ASA physical status I or II), the median (interquartile range) area of MAP <65 mmHg was 3.0 (0 to 20) mmHg∙min in the continuous monitoring group and 3.3 (0 to 20) mmHg∙min in 1-min oscillometry group. The upper 97.5% confidence limit for the geometric mean ratio was 1.63, meeting the noninferiority margin of 3.50 (P < 0.001 for noninferiority). Vasopressor use was significantly greater in the continuous monitoring group (61% vs. 41%; P = 0.003), primarily driven by more frequent phenylephrine administration (24% vs. 7%; P = 0.001).
CONCLUSIONS: Induction hypotension was rare, and the area of MAP <65 mmHg was noninferior with oscillometric monitoring at 1-min interval versus continuous arterial pressure monitoring in relatively healthy patients. High-frequency oscillometric monitoring may be a safe and pragmatic alternative to pre-induction arterial catheterization.