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DP64: VASOPRESSOR REQUIREMENTS ACROSS ANESTHETIC MODALITIES DURING TRANSESOPHAGEAL ECHOCARDIOGRAPHY IN SEVERE LEFT VENTRICULAR DYSFUNCTION
Renee Cress; Emuejevoke Chuba, MD, MSCR; Terrie Vasilopoulos, PhD; Anson Wang, MD; Thomas J Lewandowski, FACC, FASE; Yong G Peng, MD, PhD, FASE, FASA
University of Florida
Background: Patients with severely reduced left ventricular ejection fraction (LVEF < 30%) are at increased risk of hemodynamic instability during transesophageal echocardiography (TEE). Although TEE is commonly performed under moderate sedation, differences in anesthetic administration may result in variable pharmacokinetic effects. Bolus dosing may precipitate acute hypotension with rapid anesthetic delivery, while infusion provides more gradual delivery. The influence of these modalities on intraoperative vasopressor requirements in patients with LVEF < 30% who are undergoing TEE is not known. This study evaluated the association between anesthetic delivery method and vasopressor use during TEE.
Methods: This study is a single-institution retrospective observational study of patients ≥18 years of age with LVEF < 30% who underwent TEE between January 1, 2022, and December 31, 2024. Of 111 identified patient cases, 79 met criteria for analysis and were categorized by three different anesthetic modalities: bolus only, infusion only, or combined bolus and infusion, with latter groups combined for secondary analysis. Data collected included anesthetic modality, dosages, intraoperative vital signs, vasopressor medication use (primary outcome), the number of vasopressors administered, and the specific medications given. Descriptive statistics and comparative tests (Fisher’s exact, chi square, and two-sample z tests) were used for analysis.
Results: Among the 79 cases included, 15 received boluses only, 14 received infusions only, and 50 received combined boluses and infusions. Phenylephrine (40.5%) followed by ephedrine (17.7%) were the most commonly used vasoactive agents. Rates of intraoperative vasopressor use among anesthetic modalities showed differences in both three-group analysis (bolus 33.3%, infusion 64.3%, combined 56.0%; p=0.196) and two-group (bolus only 33.3% vs infusion only/combined; p=0.083), although this did not reach statistical significance. Likewise, the use of multiple vasopressors was over double the rate in the infusion group compared to the bolus only group in two-group analysis (17.2% vs 6.7%, p=0.311). Interestingly, patients receiving any infusions were associated with significantly higher propofol dose per weight in kg compared to bolus-only (2.68 mg/kg vs 1.21 mg/kg, p=0.0006), which correlated with greater reductions in mean arterial pressure (p=0.047) and systolic blood pressure (p=0.04). This likely contributed to increased vasopressor requirements in the infusion group.
Conclusion: In this cohort of patients with LVEF < 30% undergoing TEE, infusion-based anesthetic administration was associated with greater vasopressor requirements compared to bolus only techniques. Further study with a larger cohort is needed to determine whether anesthetic delivery method, dose-related effects, or both contribute to these trends, which may help optimize anesthetic management for this high-risk population.
