One-minute oscillometric vs. continuous arterial pressure monitoring for hypotension during anesthetic induction in low-risk patients: A randomized noninferiority trial

초록

Study Objective: Consensus statements recommend pre-induction arterial catheterization to reduce hypotension during anesthetic induction. However, insertion is often deferred to reduce procedural delays and patient discomfort. We evaluated whether oscillometric monitoring at 1-min interval is noninferior to continuous arterial pressure monitoring on induction hypotension. Design: Bi-center randomized trial. Setting: Two tertiary university hospitals. Patients: Adults scheduled for noncardiac surgery requiring arterial catheterization. Intervention: Patients were randomized to unblinded continuous arterial pressure monitoring or to 1-min interval oscillometric monitoring with blinded intra-arterial pressures during induction. Measurements: The primary outcome was the area of mean arterial pressure (MAP) <65 mmHg during the initial 15 min of induction. Noninferiority was defined as a 10 mmHg center dot min absolute increase in the observed median of the primary outcome compared with continuous monitoring, analyzed as a geometric mean ratio. Main Results: Among 253 analyzed patients (127 in the continuous monitoring group, 126 in the 1-min oscillometry group; 71% ASA physical status I or II), the median (interquartile range) area of MAP <65 mmHg was 3.0 group. The upper 97.5% confidence limit for the geometric mean ratio was 1.63, meeting the noninferiority monitoring group (61% vs. 41%; P = 0.003), primarily driven by more frequent phenylephrine administration monitoring at 1-min interval versus continuous arterial pressure monitoring in relatively healthy patients. High

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