Comparison of routine anesthesia tracheal intubation versus modified-delayed sequence intubation on hemodynamic stability in elderly noncardiac surgical patients: a retrospective cohort study

Abstract Purpose To compare hemodynamic stability during anesthesia induction period between routine anesthesia tracheal intubation and modified-delayed sequence intubation (mDSI) in elderly patients (≥ 65 years) undergoing noncardiac surgery. Methods A single-center retrospective study was conducted involving patients aged ≥ 65 years undergoing noncardiac surgical procedures. Hemodynamic outcomes during anesthesia induction encompassed duration of hypotensive episodes, mean rate-pressure product (RPP), mean arterial pressure, and administration patterns of vasoactive agents. Propensity score matching (PSM) was implemented to balance covariates and mitigate potential confounding effects. Results The study cohort comprised 9,828 elderly patients, including 8,770 cases of routine anesthesia tracheal intubation and 1,058 cases of mDSI. Following PSM, comparative analysis revealed significantly reduced hypotension duration in the mDSI group compared to the routine anesthesia tracheal intubation group: 6.5 (6.0–7.5) vs. 1.0 (0–3.0) minutes, respectively ( p < 0.001). Hemodynamic assessment showed significantly higher RPP values in the routine anesthesia tracheal intubation cohort [12,432 (8,142–15,480) mmHg·bpm] versus the mDSI group [9,993 (8,362–11,243) mmHg·bpm, p < 0.001]. Pharmacological analysis indicated reduced vasoactive agent requirements in the mDSI group, including lower cumulative dosages of phenylephrine, esmolol, and urapidil. Conclusion The mDSI demonstrates efficacy in maintaining the circulatory stability during anesthesia induction, facilitating a smooth induction process for elderly surgical patients.