Faktori rizika za pojavu intraoperativnih varijacija vrednosti krvnog pritiska i srčanih disritmija tokom tireoidne hirurgije

Introduction/Objective Intraoperative variations in blood pressure and/or cardiac dysrhythmias (IOVBP/CD) represent one of the most common causes of morbidity and mortality in surgical patients. The aim of the study was to determine the incidence and risk factors for IOVBP/CD in thyroid surgery patients with comorbidities. Methods The study included 1,252 euthyroid patients with ASA 2 and ASA 3 status (American Society of Anesthesiologists - physical status classification) who underwent thyroid surgery. The following risk factors were examined: sex, age, body mass index (BMI), ASA status, admission diagnoses, type of operation, duration of surgery, time under general anesthesia, difficult intubation of trachea, and coexisting diseases - hypertension, cardiomyopathy, cardiac arrhythmias, angina pectoris, diabetes mellitus, kidney disease. The following intraoperative events were recorded: hypertension, severe hypertension, hypotension, and cardiac arrhythmias. We used Pearson χ2 square test, univariate, and multivariate logistic regression for statistical analysis. Results The majority of patients were female (86.3%). In 903 (72.1%) patients IOVBP/CD were detected. The most common problem was intraoperative hypertension (61.4%). Eight risk factors for IOVBP/CD were registered by univariate analysis: advanced age, ASA 3 status, BMI > 25 kg/m2, duration of surgery, time under general anesthesia, hypertension, and cardiomyopathy as a coexisting disease. The multivariate regression model identified three independent predictors for IOVBP/CD: age, hypertension, and cardiomyopathy. Conclusion IOVBP/CD are common in thyroid surgery. The most common is intraoperative hypertension. Older age, hypertension, and cardiomyopathy as a coexisting disease are independent risk factors for IOVBP/CD.Uvod/Cilj Intraoperativne varijacije krvnog pritiska i/ ili srčane disritmije (IVKP/SD) jedan su od najčešćih uzročnika morbiditeta i mortaliteta hirurških bolesnika. Cilj studije je bio da ispita učestalost i faktore rizika za pojavu IVKP/SD u tireoidnoj hirurgiji kod bolesnika sa komorbiditetima. Metode Ispitivanje je obuhvatilo 1252 eutireoidna bolesnika ASA 2 i ASA 3 statusa podvrgnutih tireoidnoj hirurgiji. Ispitivan je uticaj sledećih faktora rizika: pol, starost, indeks telesne mase (ITM), ASA status, prijemna dijagnoza, tip operacije, trajanje operacije, trajanje anestezije, otežana intubacija traheje, kao i komorbiditeti: hipertenzija, kardiomiopatija, srčane aritmije, angina pektoris, dijabetes melitus, bolesti bubrega. Registrovani su intraoperativno: hipertenzija, hipertenzivna kriza, hipotenzija i srčane aritmije. Korišćen je Pirsonov χ2-test, univarijantna i multivarijantna regresiona analiza za statističku obradu podataka. Rezultati Većinu bolesnika su činile žene (86,3%). IVKP/ SD su registrovani kod 903 (72,1%) bolesnika. Najčešći poremećaj je bila intraoperativna hipertenzija - 61,4%. Univarijantnom analizom je registrovano sedam faktora rizika za pojavu IVKP/SD: godine života, ASA 3 status, ITM > 25 kg/m2, trajanje hirurgije, trajanje anestezije, hipertenzija i kardiomiopatija kao komorbiditet. Multivarijantnom regresionom analizom izdvojila su se tri nezavisna prediktora pojave IVKP/SD: godine starosti, hipertenzija i kardiomiopatija. Zaključak IVKP/SD su česte u tireoidnoj hirurgiji. Najčešća je intraoperativna hipertenzija. Starije životno doba, hipertenzija i kardiomiopatija kao koegzistirajuće bolesti su nezavisni faktori rizika za pojavu IVKP/SD

Risk Factors for Intraoperative Hypertension during Surgery for Primary Hyperparathyroidism

Objective: To investigate the incidence and identify risk factors for the occurrence of intraoperative hypertension (IOH) during surgery for primary hyperparathyroidism (pHPT). Subjects and Methods: The study included 269 patients surgically treated between January 2008 and January 2012 for pHPT. IOH was defined as an increase in systolic blood pressure >= 20% compared to baseline values which lasted for 15min. The investigated influence were demographic characteristics, surgical risk score related to physical status (based on the American Society of Anesthesiologists [ASA] classification), comorbidities, type and duration of surgery, and duration of anesthesia on IOH occurrence. The investigated factors were obtained from the patients' medical history, anesthesia charts, and the daily practice database. Logistic regression analysis was done to determine the predictors of IOH. Results: Of the 269 patients, 153 (56.9%) had IOH. Based on the univariate analysis, age, body mass index, ASA status, duration of anesthesia, and preoperative hypertension were risk factors for the occurrence of IOH. Multivariate analysis showed that independent predictors of IOH were a history of hypertension (OR = 2.080, 95% CI: 1.102-3.925, p = 0.024) and age (OR = 0.569, 95% CI: 0.360-0.901, p = 0.016). Conclusion: In this study, a high percentage (56%) of the patients developed IOH during surgery for pHPT, which indicates that special attention should be paid to these patients, especially to the high-risk groups: older patients and those with a history of hypertension. Further, this study showed that advanced age and hypertension as a coexisting disease prior to parathyroid surgery were independent risk factors for the occurrence of IOH