[Turk J Anaesthesiol Reanim]
Turk J Anaesthesiol Reanim. Baskıdaki Makaleler: TARD-47154

Association of Low Blood Pressure, Low Bispectral Index and Low Minimum Alveolar Concentration of Anaesthetic During Surgery with Post-operative 30-Day Mortality: A Systemic Review and Meta-Analysis

Tak Kyu Oh1, Young Mi Park2, In Ae Song1, Sang Hon Park3
1Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
2Medical Research Collaborating Center, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, Korea 463-707
3Division of Intensive Care Medicine, Sheikh Khalifa Specialty Hospital, Ras Al Khaimah, United Arab Emirates.

Objective: Triple low state [low mean arterial pressure (MAP), low BIS, and a low minimum alveolar concentration (MAC) fraction of anaesthetic during surgery] has been a controversial topic of interest in clinical practice. This study is a systematic review of previous studies concerning the effects of the triple low state on post-operative 30-day mortality and conducted a meta-analysis with a sample size bigger than that in previous studies.
Methods: After searching for relevant articles in the Pubmed database on March 27, 2017, we included studies that compared post-operative 30-day mortality between triple low and non-triple low groups. Identified articles were subjected to initial screening using keywords(‘low bispectral index’, ‘intraoperative hypotension’ and ‘low minimum alveolar concentration’) according to the Prisma Flow diagram (2009).
Results: Three retrospective cohort studies were included for meta-analysis. The combined total of subjects in the triple low and reference groups was 29,402 and 17,428, respectively; the sample size was 46,830. We derived an HR of 1.09 (95% CI, 1.07–1.11) for the fixed effect model and 1.30 (95% CI, 1.04–1.07) for the random effect model. In the analysis of heterogeneity among the three studies, I2 = 95% was obtained (P < 0.01). As a result, the values obtained from the random effect model were used and the HR was 1.30 for the triple low group, indicating a 30% increase in the overall 30-day mortality.
Conclusion: The present study demonstrated that patients exposed to the triple low state exhibit higher 30-day mortality rates compared with those who are not exposed.

Keywords: Hypotension, Bispectral Index, Anesthesia

Sorumlu Yazar: In Ae Song, South Korea

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