Carotid Artery Corrected Flow Time and Inferior Vena Cava Collapsibility Index for Prediction of Hypotension After Induction of General Anesthesia in Geriatric Patients Undergoing Elective Surgery

Tanta University

Status: Enrolling

Conditions: Hypotension on Induction; Geriatrics; Elective Surgery; General Anesthetic Drug Adverse Reaction

Treatments: Diagnostic Test: Carotid Artery Corrected Flow Time measurement; Diagnostic Test: Inferior vena cava collapsibility index

Study type: Observational

Funder types: Other

Identifiers

NCT06814054

Hypotension in geriatrics

Details and patient eligibility

About

In this observational study, we will assess cFT by Carotid ultrasound and IVC collapsibility index for prediction of hypotension after induction of general anesthesia in geriatric patients undergoing elective surgery.

Full description

Following the onset of general anesthesia, hypotension is frequently observed, and intraoperative hypotension is linked to end organ damage following surgery, including cardiac ischemia and severe renal injury. postoperative end-organ damage depends on the duration and magnitude.

The incidence of hypotension after induction of general anesthesia varies and is influenced by the induction agent, patient characteristics, and the definition of hypotension.

Hypotension was defined by a 30% reduction in the SBP or 20% reduction in the MAP from baseline or an absolute SBP of less than 90 mm Hg and MAP of less than 65 mm Hg within 3 minutes after induction of general anesthesia.

Elderly people are more likely to experience hemodynamic fluctuation and hypotension due to the high prevalence of left ventricular diastolic failure, lower vascular reactivity and higher sensitivity to anesthetics. More significantly, older patients can't tolerate hypotension for a long time.

A variety of hemodynamic monitoring techniques have been used to predict post- anesthetic hypotension. Non-invasive cardiometry, ultrasound evaluation of fluid status, and pulse oximetry variables, such as the perfusion index and pulse variability index, were utilized.

Zhang and Critchley demonstrated that preoperative hypovolemia predicted postinduction hypotension as determined by the inferior vena cava (IVC) diameter and IVC collapsibility index.

In many clinical situations, volume-responsive patients have been identified using Doppler-derived metrics such as the peak blood flow peak velocity variation (ðVpeak) and the common carotid artery corrected flow time (cFT).

The carotid artery Doppler measures provide several benefits, including being noninvasive and being technically simple to obtain due to the carotid artery's superficial nature. Since the common carotid artery cFT is unaffected by respiratory attempts, it can also be used to assess a patient's volume responsiveness when they are breathing on their own.

Enrollment: 189 estimated patients

Sex: All

Ages: 65+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• American Society of Anaesthesiologists Physical Status I to Ⅱ
• receiving general anesthesia for elective surgery
• fasted for at least 6 to 8 hours were recruited in this study

Exclusion criteria

• • patients who refused to participate in the study

  • American Society of Anaesthesiologists Physical Status Ⅲ or Ⅳ
  • Patients with a history of peripheral arterial diseases or atherosclerosis
  • Patients with body mass index of greater than 30 kg/m2
  • Patients with arrhythmia or cardiomyopathy
  • Chronic obstructive pulmonary disease (COPD)
  • baseline systolic arterial pressure (SAP) ≥ 180 mmHg or < 90mmHg
  • Any episode of desaturation or difficult intubation during general anasethia induction

Trial design

189 participants in 1 patient group

GA induced hypotension in geriatrics

Description:

Postinduction hypotension will be defined as either * A 30% drop in SBP or 20% drop in MAP from baseline, or an absolute SBP of less than 90 mm Hg and MAP of less than 65 mm Hg within three minutes of general anaesthesia induction, every minute until 15 min after endotracheal intubation and before the start of any surgical manipulations. * Since endotracheal intubation and direct laryngoscopy can generate sympathetic activation, which will change blood pressure, we decided to start haemodynamic monitoring three minutes post endotracheal intubation. * If the MAP was less than 65 mmHg, a 250 ml crystalloid bolus will be administered and repeated as necessary. * If hypotension persist after IV fluid bolus, ephedrine will be given by three milligrams. At the end of surgery.

Treatment:

Diagnostic Test: Inferior vena cava collapsibility index

Diagnostic Test: Carotid Artery Corrected Flow Time measurement