BACKGROUND/OBJECTIVES In the context of an aging surgical population, appropriate anesthetic induction dose adjustments for the older adult remain poorly defined. In the present study, we describe the prevalence of excess induction agent dose in reference to US Food and Drug Administration (FDA) guidance and seek to investigate the possible association of such excess dose with postinduction hypotension and postoperative acute kidney injury (AKI). STUDY DESIGN A retrospective observational study was conducted in a large tertiary teaching hospital in accordance with our a priori analytic protocol as registered on ClinicalTrials.gov (NCT03699696). For inclusion, patients had to be 65 years or older and to have received general anesthesia with propofol induction for gynecologic oncology surgery between December 1, 2014 and July 8, 2018. Descriptive variables of the patients, machine-captured perioperative vital signs, induction anesthetic, and vasopressor/inotrope administrations were recorded. MAIN OUTCOME MEASURES A total of 541 female patients met inclusion criteria. The mean (standard deviation) age of the cohort was 72.20 (5.93) years. Regarding the primary outcome, 65.43% (354 patients, 95% confidence interval 61.2-69.4) of the cohort received more than the FDA recommended 1-1.5 mg/kg induction dose for patients of advanced age undergoing general anesthesia. RESULTS The percentage of patients receiving doses in excess of the FDA guidance remained substantial across all age groups, but decreased progressively with increasing 5-year age intervals (from 74% among those aged 65-69 years to 44% among those aged > 80 years). Excess propofol dose in the present cohort was not associated with our a priori definition of postinduction hypotension. Regarding AKI, among the 30 patients suffering this outcome, it occurred less often in patients who received higher propofol doses (4.1% [9/217] vs. 15.3% [21/138], p < 0.001), a result that may have been confounded by differential rates of missingness. CONCLUSIONS Older adults commonly receive propofol induction doses in excess of the FDA guidance. The immediate hemodynamic effects of these doses on postinduction hypotension were not seen in the present cohort, suggesting that propofol dose adjustments may serve as a marker of physicians' judgments as to the frailty of patients. The relevance of the AKI association is difficult to interpret due to the non-differential missingness of AKI data between the two groups.

中文翻译：

---

女性老年人麻醉诱导剂量分析。

背景/目标 在老龄化手术人群的背景下，对老年人进行适当的麻醉诱导剂量调整仍然不明确。在本研究中，我们参考美国食品和药物管理局 (FDA) 的指南描述了诱导剂过量使用的流行情况，并试图调查此类过量诱导剂与诱导后低血压和术后急性肾损伤 (AKI) 之间的可能关联。研究设计 根据我们在 ClinicalTrials.gov (NCT03699696) 上注册的先验分析方案，在一家大型三级教学医院进行了一项回顾性观察研究。纳入的患者必须年满 65 岁，并且在 2014 年 12 月 1 日至 2018 年 7 月 8 日期间接受了丙泊酚诱导全身麻醉以进行妇科肿瘤手术。记录了患者的描述性变量、机器捕获的围手术期生命体征、诱导麻醉剂和血管加压药/正性肌力药的给药情况。主要观察指标 共有 541 名女性患者符合纳入标准。队列的平均（标准差）年龄为 72.20 (5.93) 岁。关于主要结果，队列中 65.43%（354 名患者，95% 置信区间 61.2-69.4）接受了超过 FDA 推荐的 1-1.5 mg/kg 诱导剂量，用于接受全身麻醉的高龄患者。结果 接受超过 FDA 指导剂量的患者百分比在所有年龄组中仍然很大，但随着 5 岁年龄间隔的增加而逐渐减少（从 65-69 岁的 74% 到 80 岁以上的 44% ）。本队列中过量的丙泊酚剂量与我们对诱导后低血压的先验定义无关。关于 AKI，在遭受这种结果的 30 名患者中，接受较高丙泊酚剂量的患者发生这种情况的频率较低（4.1% [9/217] 对 15.3% [21/138]，p < 0.001），这一结果可能与被不同的缺失率混淆了。结论 老年人通常接受超过 FDA 指导的丙泊酚诱导剂量。在本队列中未观察到这些剂量对诱导后低血压的直接血流动力学影响，这表明丙泊酚剂量调整可作为医生判断患者虚弱程度的标志。由于两组之间 AKI 数据的非差异性缺失，AKI 关联的相关性难以解释。