• Achmet Ali, Oguzhan Altiparmak, Aylin Tetik, Demet Altun, Nukhet Sivrikoz, Mehmet Buget, Sahika Bolsoy, Nihan Yaman, and Ibrahim O Akinci.
• Department of Anesthesiology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey.
• J Neurosurg Anesthesiol. 2017 Jul 1; 29 (3): 304-311.

BackgroundHypotension after anesthesia induction is a common problem and is partly related to patient volume status. The present study aimed to investigate the correlation between blood pressure change and pulse pressure variation (PPV), and percentage of weight loss while determining threshold for hypotension by receiver operating characteristic analysis.MethodsWe analyzed 231 neurosurgery patients. In all patients, propofol was used for standard anesthesia induction. Patient demographics, medical histories, fasting duration, percentage weight loss, baseline blood pressure, and PPV during normal tidal volume breathing and that during forced inspiratory breathing (PPVfi) were recorded. Hemodynamic changes within 10 minutes of intubation were observed. Patients developing hypotension and severe hypotension were determined; lowest mean arterial pressure (MAP) and systolic arterial pressure (SAP) values were recorded, and their differences relative to baseline values were calculated.ResultsThe incidence of hypotension was 18.6%. Both percentage weight loss and PPVfi were correlated with the changes in MAP and SAP. A PPVfi>14 identified all observed hypotensive episodes with 86% sensitivity and 86.2% specificity, whereas percentage weight loss >1.75% identified all observed hypotensive episodes with 81.4% sensitivity and 70.7% specificity. Furthermore, PPVfi>16.5 identified severe hypotension with 85% sensitivity and 90.5% specificity, whereas percentage weight loss >1.95% identified severe hypotension with 85% sensitivity and 73% specificity.ConclusionsPercentage weight loss and PPVfi are good predictors of hypotension after anesthesia induction and, thus, may allow anesthesiologists to adopt preventative measures and ensure safer anesthesia induction.

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