Anaesthesia, critical care & pain medicine · 2025
Clinical practices in hemodynamic management of post-induction hypotension in chronic hypertension: A study of certified registered nurse anesthetists' strategies.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод пока не подготовлен
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Ayme Olivier, Chapalain Elisabeth, Romuald Jean-Jacques, Langeron Olivier, Caillard Anaïs
Аннотация
INTRODUCTION: Post-induction hypotension is a common complication in general anesthesia, particularly in patients with chronic hypertension. This study aims to analyze the practices of Certified Registered Nurse Anesthetist (CRNA) in collaboration with anesthesiologists of hemodynamic management in these patients.
METHODOLOGY: A multicenter quantitative descriptive survey was conducted among CRNAs working in 11 public and private hospitals. A questionnaire was developed to compare the management of two clinical cases: the first involved a hypertensive patient undergoing low-risk surgery, while the second described an older patient with multiple comorbidities undergoing high-risk surgery. The hemodynamic monitoring methods used by CRNAs were evaluated.
RESULTS: Of the 158 CRNAs who responded (48.2% of 352 surveyed), 85% reported using mean arterial pressure (MAP) as their monitoring target. MAP targets ranged from 75 ± 9 mmHg for the first case to 80 ± 11 mmHg for the second. The study shows that 88% of CRNAs titrate anesthetics (over 70% using depth monitoring), and 70% start norepinephrine before the first induction. These rates rise to 94% and 99% for the second case. Norepinephrine is the first-line treatment for hypotension, while fluid loading comes fourth after Trendelenburg and anesthetic reduction. In the second, pulse wave analysis is most used (53%), followed by oesophageal Doppler (25%). Despite the availability of non-invasive stroke volume monitoring, 35% of CRNAs express interest in its implementation.
CONCLUSION: These findings highlight a predominant shift among CRNAs toward proactive, vasoactive-centered hemodynamic management.
METHODOLOGY: A multicenter quantitative descriptive survey was conducted among CRNAs working in 11 public and private hospitals. A questionnaire was developed to compare the management of two clinical cases: the first involved a hypertensive patient undergoing low-risk surgery, while the second described an older patient with multiple comorbidities undergoing high-risk surgery. The hemodynamic monitoring methods used by CRNAs were evaluated.
RESULTS: Of the 158 CRNAs who responded (48.2% of 352 surveyed), 85% reported using mean arterial pressure (MAP) as their monitoring target. MAP targets ranged from 75 ± 9 mmHg for the first case to 80 ± 11 mmHg for the second. The study shows that 88% of CRNAs titrate anesthetics (over 70% using depth monitoring), and 70% start norepinephrine before the first induction. These rates rise to 94% and 99% for the second case. Norepinephrine is the first-line treatment for hypotension, while fluid loading comes fourth after Trendelenburg and anesthetic reduction. In the second, pulse wave analysis is most used (53%), followed by oesophageal Doppler (25%). Despite the availability of non-invasive stroke volume monitoring, 35% of CRNAs express interest in its implementation.
CONCLUSION: These findings highlight a predominant shift among CRNAs toward proactive, vasoactive-centered hemodynamic management.