Measuremnt of width of major blood vessel through a scan to predict decrease in blood pressure due to a drug

Not yet recruiting

• Conditions: Measurement and Monitoring,

• Registration Number: CTRI/2019/06/019733
• Lead Sponsor: S N Medical College and HSK hospital

Brief Summary

Hypotension is common during surgery in patients under anesthesia and may cause organ underperfusion and ischemia. After induction of general anesthesia, patients are at particular risk of developing hypotension because of the cardiovascular depressant and vasodilatory effects of anesthetic agents, as well as lack of surgical stimulation. Furthermore, patients may have preexisting hypovolemia resulting from dehydration and impaired compensatory responses, which increase the risk. Severe episodes of intraoperative hypotension have been proposed as an independent risk factor in the development of postoperative adverse outcomes such as myocardial infarction, stroke, heart failure, acute kidney injury, prolonged hospital stay, and even increased 1-yr mortality rates both in patients undergoing cardiac surgery and in those undergoing noncardiac surgery. Predictors of hypotension after induction of anesthesia include American Society of Anesthesiologists physical status (ASA) III and IV, baseline mean arterial pressure lower than 70 mmHg, age more than 60yr, use of high fentanyl dose. Heart rate (HR) variability can predict hypotension and bradycardia after induction of anesthesia. However, the role of preoperative volume status in the development of hypotension after induction will not been assessed fully. A surgical patient’s preoperative volume status may vary due to physical status, comorbidities, and preoperative treatments such as bowel preparation and fasting, and these contributory factors have been shown to have an influence on the patient’s susceptibility to intraoperative hypotension. Assessing intravascular volume status is a challenge for clinicians. Traditional static parameters such as central venous pressure have been criticized for invasiveness and lack of accuracy. A number of dynamic parameters that assess volume status have been recommended recently. Ultrasound measurements of inferior vena cava (IVC) diameter with respiration, which include (1) maximum diameter of the IVC (dIVCmax) at the end of expiration during spontaneous respiration and (2) collapsibility index (CI), have been recommended as rapid and noninvasive methods for estimating volume status. These parameters have been proposed as repeatable and easily obtainable parameters by operators with little experience in echocardiography. Ultrasound measurement of the IVC has been studied extensively as a predictor of fluid responsiveness in different clinical settings, and several studies have demonstrated that dIVCmax and CI are reliable indicators of intravascular volume status. Therefore, we hypothesized that preoperative dIVCmax and its respiratory variation, that is, CI, could predict the incidence of hypotension after induction of general anesthesia.

Detailed Description

Not available

Study Timeline

• Last Update Posted: 2019-12-06
• Study Start: 2020-01-07

Recruitment & Eligibility

• Status: Not Yet Recruiting
• Sex: All
• Target Recruitment: 100

Inclusion Criteria

• Patients aged between 18 to 60 yrs.
• ASA (American society of anesthesiologist) grade I and II.
• Patients posted for surgery under general anaesthesia.

Exclusion Criteria

• Patients with major peripheral vascular disease 2.
• Unstable angina or ejection fraction less than 40% 3.
• Respiratory distress 4.
• Increased intraabdominal pressure 5.
• Autonomic nervous system disorders 6.
• Anticipated difficult airway 7.
• Mental incompetence 8.
• Patients who have currently taken angiotensin-converting enzyme inhibitor or angiotensin receptor blocker will be excluded.

Study & Design

• Study Type: Observational
• Study Design: Not specified

Primary Outcome Measures

Name	Time	Method
To investigate whether preoperative ultrasound IVC measurements could predict hypotension after induction of anesthesia by ultrasound measurements of IVC collapsibility index	10 minutes after induction

Secondary Outcome Measures

Name	Time	Method
Hypotension associated complication	10 minutes after induction

Trial Locations

Locations (1)

S Nijalingappa Medical College and HSK Hospital; 🇮🇳 Bagalkot, KARNATAKA, India

S Nijalingappa Medical College and HSK Hospital

🇮🇳Bagalkot, KARNATAKA, India

Dr Manjunath B

Principal investigator

9480013943

manjunath0993@gmail.com