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Retrospective analysis of risk factors of hypotensive bradycardic events during shoulder arthroscopic surgery under interscalene blockade in the sitting position

대한마취과학회지 2020년 73권 6호 p.542 ~ 549
류태하, 김백진, 우성준, 이소영, 임정아, 곽상규, 노운석,
소속 상세정보
류태하 ( Ryu Tae-Ha ) - Daegu Catholic University School of Medicine Department of Anesthesiology and Pain Medicine
김백진 ( Kim Baek-Jin ) - Good Morning Hospital Department of Anesthesiology and Pain Medicine
우성준 ( Woo Seong-Jun ) - Daegu Catholic University School of Medicine Department of Anesthesiology and Pain Medicine
이소영 ( Lee So-Young ) - Daegu Catholic University School of Medicine Department of Anesthesiology and Pain Medicine
임정아 ( Lim Jung-A ) - Daegu Catholic University School of Medicine Department of Anesthesiology and Pain Medicine
곽상규 ( Kwak Sang-Gyu ) - Daegu Catholic University School of Medicine Department of Medical Statistics
노운석 ( Roh Woon-Seok ) - Daegu Catholic University School of Medicine Department of Anesthesiology and Pain Medicine

Abstract


Background: Hypotensive bradycardic events (HBEs) are a frequent adverse event in patients who underwent shoulder arthroscopic surgery under interscalene block (ISB) in the sitting position. This retrospective study was conducted to investigate the independent risk factors of HBEs in shoulder arthroscopic surgery under ISB in the sitting position.

Methods: A total of 2549 patients who underwent shoulder arthroscopic surgery under ISB and had complete clinical data were included in the study. The 357 patients who developed HBEs were included in the HBEs group, and the remaining 2192 in the non-HBEs group. The potential risk factors for HBEs, such as age, sex, past medical history, anesthetic characteristics, and intraoperative medications were collected and compared between the groups. Statistically significant variables were included in a logistic regression model to further evaluate the independent risk factors for HBEs in shoulder arthroscopic surgery under ISB.

Results: The incidence of HBEs was 14.0% (357/2549). Logistic regression analysis revealed that the intraoperative use of hydralazine (odds ratio [OR] 4.2; 95% confidence interval [CI] 2.9?6.3), propofol (OR 2.1; 95% CI 1.3?3.6), and dexmedetomidine (OR 3.9; 95% CI 1.9?7.8) before HBEs were independent risk factors for HBEs in patients who received shoulder arthroscopic surgery under ISB.

Conclusions: The intraoperative use of antihypertensives such as hydralazine and sedatives such as propofol or dexmedetomidine leads to increased risk of HBEs during shoulder arthroscopic surgery under ISB in the sitting position.

키워드

Brachial plexus block; Bradycardia; Hypotension; Logistic regression; Risk factors; Shoulder arthroscopy; Syncope

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