June 1994

Risk of Hypotension During Apnea Testing

Author Affiliations

From the Department of Neurology, State University of New York Health Science Center at Brooklyn. Dr Jeret is now in private practice in Rockville Centre, NY.

Arch Neurol. 1994;51(6):595-599. doi:10.1001/archneur.1994.00540180073016

Objective:  To determine the safety of apnea testing.

Design:  Prospective, consecutive study.

Setting:  Inner-city trauma center.

Patients:  A total of 70 apnea tests were performed on 61 comatose patients as part of the determination of brain death.

Results:  Only 43 examinations (61%) were well tolerated. During 27 examinations (39%) patients either developed marked hypotension (≥ 15% drop in mean arterial pressure) (n=23) or required prophylactic vasopressor manipulation (n=4). Of the 27 examinations in which hypotension developed, 14 were aborted, two were tolerated despite marked hypotension, four were tolerated after administration of prophylactic epinephrine (n=1) or dopamine hydrochloride (n=3), seven were successfully completed after increases in the rate of dopamine infusion during the test.

Conclusions:  Hypotension can pose a significant risk to patients undergoing apnea testing. Constant monitoring of vital signs throughout the test is essential to its safe completion.