Effect of Fluid Therapy in Early Morning on the Incidence of Post-Induction Hypotension During Non-Cardiac Surgery After Noon: A Single-Center Retrospective Study

Abstract

Purpose

Post-induction hypotension (PIH) is a common clinical phenomenon linked to increased morbidity and mortality in various non-cardiac surgeries. Patients with surgery in the afternoon may have preoperative hypovolemia caused by prolonged fasting and dehydration, which increases the risk of hypotension during the induction period. However, studies on the fluid therapy in early morning combating PIH remain inadequate. Therefore, we aimed to investigate the influence of prophylactic high-volume fluid in the early morning of the operation day on the incidence of PIH during non-cardiac surgery after noon.

Patients and Methods

We reviewed the medical records of patients who underwent non-cardiac surgery after noon between October 2021 and October 2022. The patients were divided into two groups based on whether they received a substantial volume of intravenous fluid (high-volume group) or not (low-volume group) in the early morning of the surgery day. We investigated the incidence of PIH and intraoperative hypotension (IOH) as well as the accumulated duration of PIH in the first 15 minutes. In total, 550 patients were included in the analysis.

Results

After propensity score matching, the incidence of PIH was 39.7% in the high-volume group and 54.1% in the low-volume group. Multivariate logistic regression analysis showed that patients in the high-volume group had lower incidence of hypotension after induction compared with the low-volume group (odds ratio, 0.55; 95% CI, 0.34–0.89; p = 0.016). The high-volume fluid infusion in the preoperative morning was significantly correlated with the decreased duration of PIH (p = 0.013), but no statistical difference was observed for the occurrence of IOH between the two groups (p = 0.075).

Conclusion

The fluid therapy of more than or equal to 1000 mL in the early morning of the surgery day was associated with a decreased incidence of PIH compared with the low-volume group in patients undergoing non-cardiac surgery after noon.

Keywords:

• anesthesia induction
• hypotension
• fluid optimization
• preoperative rehydration
• hemodynamic instability

Confidentiality of Data

The authors declare that they have followed the protocols of their center on the publication of patient data.

Data Sharing Statement

All data generated or analyzed during this study are included in the article. Further inquiries about the datasets can be directed to the corresponding author on reasonable request. The patient datasets anonymity will be preserved prior to distribution.

Ethical Disclosures Statement

Protection of human and animal subjects: The authors declare that the procedures followed were in accordance with the regulations of the relevant clinical research ethics committee and with those of the Code of Ethics of the World Medical Association (Declaration of Helsinki).

Right to Privacy and Informed Consent

The authors have obtained approval from the Ethics Committee for analysis and publication of routinely acquired clinical data. In addition, informed consent was not required for this retrospective observational study.

Acknowledgments

All authors would like to express their gratitude to the Anesthesiology Department of the Affiliated Lianyungang Hospital of Xuzhou Medical University for their assistance and support.

Disclosure

The authors report no conflicts of interest in this work.

Additional information

Funding

This research was supported by Lianyungang Science and Technology Project (JCYJ2305) and Clinical Research Fund of The Affiliated Lianyungang Hospital of Xuzhou Medical University (LC13).