Journal of Anesthesia

, Volume 32, Issue 5, pp 673–680 | Cite as

Hypotension after induction of general anesthesia: occurrence, risk factors, and therapy. A prospective multicentre observational study

  • Ondrej JorEmail author
  • Jan Maca
  • Jirina Koutna
  • Michaela Gemrotova
  • Tomas Vymazal
  • Martina Litschmannova
  • Pavel Sevcik
  • Petr Reimer
  • Vera Mikulova
  • Michaela Trlicova
  • Vladimir Cerny
Original Article



Hypotension after induction of general anesthesia (GAIH) is common in anesthesiology practice and can impact outcomes.


In this prospective multicenter, cross-sectional, observational study, the hypotension was defined as a decrease in mean arterial pressure of > 30% compared to the first measurement in the operation theatre before general anesthesia (GA) induction. Blood pressure was measured immediately at the time of endotracheal intubation (TETI), at five (T5) and 10 (T10) minutes after. All subjects aged > 18 years undergoing elective non-cardiac surgery under GA were included. The goals were description of GAIH occurrence, the association of GAIH with selected comorbidities, chronic medications, and anesthetics with GAIH, and the type and efficacy of interventions used to correct hypotension.


Data from 661 subjects, whose GA was induced with propofol and sufentanil, were analyzed. In 36.5% of subjects, GAIH was observed at ≥ 1 of the assessed time points. GAIH was present in 2.9% subjects at all time points. The probability of GAIH is raising with age, degree of hypertension at time of arrival to theatre and presence of diabetes. The type of volatile anesthetic was not associated with the occurrence of GAIH. The overall efficiency of interventions to correct hypotension was 94.4%. Bolus fluids were the most often used intervention and was 96.4% effective.


GAIH rate depends on age, degree of blood pressure decompensation prior the surgery, and presence of diabetes mellitus type II.


Hypotension Anesthesia induction General anesthesia Risk factors Predictors 



Data collection costs were financed by the internal resources of each department. Statistical analyses were supported by the internal grant agency of VSB Technical University of Ostrava, Faculty of Electrical Engineering and Computer Science, Czech Republic, under the Project No. SP2017/56.

Author contributions

OJ project design, coordination of data collection from Ostrava, writing manuscript. JM project design, language correction, writing manuscript. JK coordination of data collection from Olomouc, final manuscript check. MG coordination of data collection from Nový Jičín, final manuscript check. TV coordination of data collection from Praha, final manuscript check. ML project design, statistical analysis, final manuscript check. PŠ project design, supervision, final manuscript check. PR project design, writing manuscript. VM data management (Centers: Ostrava, Olomouc), final manuscript check. MT data management (Centers: Praha, Nový Jičín, Ústí nad Labem), final manuscript check. VČ project design, supervision, coordination of data collection from Ústí nad Labem, final manuscript check.

Compliance with ethical standards

Conflict of interest

All authors declare that they have no conflict of interest.


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Copyright information

© Japanese Society of Anesthesiologists 2018

Authors and Affiliations

  • Ondrej Jor
    • 1
    • 10
    Email author
  • Jan Maca
    • 1
    • 8
  • Jirina Koutna
    • 3
    • 4
  • Michaela Gemrotova
    • 5
  • Tomas Vymazal
    • 6
  • Martina Litschmannova
    • 7
  • Pavel Sevcik
    • 1
    • 8
  • Petr Reimer
    • 1
  • Vera Mikulova
    • 8
  • Michaela Trlicova
    • 8
  • Vladimir Cerny
    • 2
    • 9
    • 10
    • 11
  1. 1.Department of Anesthesiology and Intensive Care MedicineUniversity Hospital OstravaOstravaCzech Republic
  2. 2.Department of Anesthesiology, Perioperative Medicine and Intensive CareJ.E. Purkinje University, Masaryk HospitalUsti nad LabemCzech Republic
  3. 3.Department of Anesthesiology and Intensive Care MedicineUniversity Hospital OlomoucOlomoucCzech Republic
  4. 4.Faculty of Medicine and DentistryPalacky University OlomoucOlomoucCzech Republic
  5. 5.Department of Anesthesia and ResuscitationNovy Jicin HospitalNovy JicinCzech Republic
  6. 6.Department of Anesthesiology and Intensive Care Medicine, 2nd Faculty of MedicineCharles University in Prague and Motol University HospitalPragueCzech Republic
  7. 7.Department of Applied MathematicsTechnical University of OstravaOstravaCzech Republic
  8. 8.Department of Intensive Medicine and Forensic Studies, Faculty of MedicineUniversity of OstravaOstravaCzech Republic
  9. 9.Centrum for Research and DevelopmentUniversity Hospital Hradec KraloveHradec KraloveCzech Republic
  10. 10.Department of Anesthesiology and Intensive Care, Faculty of Medicine in Hradec KraloveCharles University in PraguePragueCzech Republic
  11. 11.Department of Anesthesia, Pain Management and Perioperative MedicineDalhousie UniversityHalifaxCanada

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