Document Detail

Preoperative exercise heart rate recovery predicts intraoperative hypotension in patients undergoing noncardiac surgery.
MedLine Citation:
PMID:  22986319     Owner:  NLM     Status:  In-Data-Review    
STUDY OBJECTIVE: To assess the predictive role of heart rate (HR) recovery in the detection of intraoperative hypotension in patients undergoing noncardiac surgery.
DESIGN: Prospective, observational study.
SETTING: Department of cardiology and operating rooms of university hospitals.
PATIENTS: 160 ASA physical status 1 and 2 patients scheduled for elective noncardiac surgery.
MEASUREMENTS: All patients underwent exercise stress testing. Maximum HRs and metabolic equivalent levels were recorded. Heart rate recovery at the first, second, and third minutes were calculated by subtracting HRs one, two, and three minutes into the recovery period from the maximal HR at peak exercise. A decrease in mean arterial pressure (MAP) of greater than 30% was defined as intraoperative hypotension and recorded. Patients were classified to two groups according to whether they had intraoperative hypotension.
MAIN RESULTS: Hypotensive episode was observed in 31 patients (19.7%) during the operation. The presence of diabetes mellitus was higher in patients with intraoperative hypotension (22.6% vs 7.1%, P = 0.019). Mean HR recovery at the first, second, and third minutes was significantly lower in the intraoperative hypotension group (P = 0.001, P = 0.004, and P = 0.031, respectively). Heart rate recovery at the first, second, and third minutes was a good predictor of intraoperative hypotension, but only HR recovery at the first minute (OR 0.82, 95% CI 0.73 to 0.92, P = 0.001) and HR recovery at the second minute (OR, 0.90; 95% CI, 0.82 to 0.98; P = 0.019) were independent predictors of intraoperative hypotension. A higher negative correlation was noted between the degree of MAP reduction and HR recovery at the first minute (r = -0.797, P = 0.001).
CONCLUSIONS: Abnormal preoperative exercise HR recovery predicts intraoperative hypotension in patients undergoing noncardiac surgery. Given the importance of intraoperative hypotension, preoperative use of exercise testing might be considered.
Emine Arzu Kose; Hasan Kutsi Kabul; Vedat Yildirim; Murat Tulmac
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of clinical anesthesia     Volume:  24     ISSN:  1873-4529     ISO Abbreviation:  J Clin Anesth     Publication Date:  2012 Sep 
Date Detail:
Created Date:  2012-09-18     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8812166     Medline TA:  J Clin Anesth     Country:  United States    
Other Details:
Languages:  eng     Pagination:  471-6     Citation Subset:  IM    
Copyright Information:
Copyright © 2012 Elsevier Inc. All rights reserved.
Department of Anesthesiology and Reanimation, Kirikkale University, School of Medicine, 71100 Kirikkale, Turkey. Electronic address:
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