Abstract:

Objective To analyze the intraoperative hemodynamic management by hypotension prediction index （HPI） in one patient underwent robot-assisted laparoscopic cystectomy， and to provide the reference for anesthesia monitoring and hemodynamic management in the similar major surgery. Methods The clinical data， intraoperative hemodynamic data， usage and dosage of vasoactive drugs， and clinical outcomes of one patient underwent robot-assisted laparoscopic cystectomy with HPI-guided intraoperative hemodynamic management were retrospectively analyzed， and the relevant literatures were reviewed. Results The patient， a 72-year-old female， was admitted due to macroscopic hematuria for 5 months accompanied by dysuria for 3 months. The cystoscope results showed a 7 cm×7 cm×5 cm mass on the right side of the bladder trigone and a 4 cm×3 cm×3 cm mass near the bladder neck. The positron emission tomography/computed tomography （PET/CT） results showed thickening of the right posterior bladder wall with high metabolism， and the preliminary diagnosis was bladder malignancy. After preoperative anesthesia evaluation， the robot-assisted laparoscopic cystectomy was planned. After entering the operating room， the routine monitoring was conducted， and the monitor equipped with HPI software was used to guide intraoperative hemodynamic management. After routine anesthesia induction， the tracheal intubation was performed by video laryngoscope. The patient experienced intraoperative hypotension （IOH） for six times， the cumulative time of mean arterial pressure （MAP）<65 mmHg was 13.7 min， accounting for 4.40% of the anesthesia duration， and the time-weighted average of MAP<65 mmHg was 0.28 mmHg. The time range with HPI≥85 roughly overlapped with and included the period of MAP<65 mmHg. At 146 time points with HPI≥85，the MAP remained greater than 65 mmHg at 68.5% （100/146） of the points. At 47 time points with MAP<65 mmHg， HPI≥85 occurred at 97.9% （46/47） of the points. On the first postoperative day， the patient’s hypersensitive cardiac troponin I was <0.01 μg·L^-1， and no perioperative adverse events occurred. The patient was discharged on the eighth day. Conclusion HPI can promptly and accurately predict the occurrence of IOH in the patients undergoing robot-assisted laparoscopic cystectomy. The use of HPI-based hypotension correction strategies during surgery can maintain the time-weighted average of MAP<65 mmHg at a lower level.

Key words: Hypotension, Hypotension prediction index, Machine learning, Hemodynamic management, Case report