Comparison of common carotid artery corrected flow time and inferior vena cava collapsibility index measured by ultrasonography for prediction of hypotension after general anesthesia in adult patients undergoing elective gastro-intestinal surgery
试验速览
- 阶段
- 不适用
- 状态
- 尚未招募
- 发起方
- 入组人数
- 100
- 试验地点
- 1
- 主要终点
- To compare the predictive value of corrected common carotid artery flow time and IVC collapsibility index for hypotension after general anesthesia
研究概览
简要总结
Hypotension is common after induction of general anesthesia¹, and
intraoperative hypotension is associated with postoperative end-organ injury2,3.
The incidence of hypotension after induction of general anaesthesia is variable
and depends on the patients characteristics, volume status of the patient, and the
induction agent used4,.Immediately after induction of general anaesthesia,
patients are at particular risk of hypotension because of the cardiovascular
depressant and vasodilatory effects of induction agents, as well as a lack of
surgical stimulation. Furthermore, patients undergoing elective gastro-intestinal
surgery may be hypovolemic for multiple reasons, such as preoperative fasting,
bowel preparation, etc. Hypovolemia increases the risk of hypotension3,4Despite
worldwide improvement in preoperative optimization and changing practices
promoting the avoidance of unnecessary fasting and bowel preparation, post-
anaesthesia induction hypotension is still a concern.
Latent hypovolemia where there is a decrease in circulating blood volume
without obvious hemodynamic changes and/or organ dysfunction increases the
risk of the development of hypoperfusion in response to external impacts such
as anaesthesia and surgery5
.Preoperative assessment of intravascular volume
statusand identification of latent hypovolemia can help clinicians to ensure
patient safety and a chance to implement proper fluid replacement before
inducing general anaesthesia.
A number of dynamic parameters that assess volume status have been
recommended recently to guide perioperative fluid therapy6 In addition Point of
care ultrasound assessment of major vessels is being increasingly used by
clinicians to assess intravascular volume status.7
Ultrasound measurements of
inferior vena cava (IVC) diameter with respiration and IVC collapsibility index (CI), have been recommended as rapid non-invasive methods for estimating
volume status and to predict hypotension after anaesthesia8,9
However, an assessment of the IVC has several limitations, such as it
may be difficult to obtain IVC measurements in patients with distended
abdomen and it may be of limited utility when there are excessive respiratory
efforts
10
.
Carotid artery Doppler measurements have several advantages, as it is
non-invasive, and because the carotid artery is a superficial artery, it is
technically easy to obtain measurements.Corrected Flow Time (cFT) for
carotid artery is the carotid systole time, with heart rate correction
applied.11It is reported to correlate with intravascular volume status.
12The
common carotid artery corrected flow time(cFT) is not affected by respiratory
efforts; hence, it also can be used as a marker of volume responsiveness in
spontaneously breathing patients.13 .The cFT measured in the common carotid
artery has also been reported as predictor of hypotension after induction of
general anaesthesia14
This study aims to compare Common carotid
arterycFT&IVCcollapsibility index for predicting post -induction hypotension
in adult patients undergoing elective gastro-intestinal surgery.
研究设计
- 研究类型
- Observational
入排标准
- 年龄范围
- 18.00 Year(s) 至 45.00 Year(s)（—）
- 性别
- All
入选标准
- •All patients undergoing elective gastrointestinal surgery with General anesthesia age
- •45 years. 1)American Society of Anesthesiologists – Physical status (ASA-PS:I, II,III) 2)Patient willing to participate in our study.
排除标准
- •Patient with peripheral artery disease.
- •Patients with known carotid artery stenosis.
- •Pregnant patients.
- •Patients with cardiac comorbidity and arrhythmia.
- •Patients with history of neck surgery/neck trauma 5)Patients with respiratory distress.
- •Patients with increased intra-abdominal pressure.
结局指标
主要结局
To compare the predictive value of corrected common carotid artery flow time and IVC collapsibility index for hypotension after general anesthesia
时间窗: 2,4,6,10.15,20,25, 30 min after induction of anaesthesia
time and inferior vena cava collapsibility index for hypotension after general
时间窗: 2,4,6,10.15,20,25, 30 min after induction of anaesthesia
anaesthesia in patients undergoing surgery
时间窗: 2,4,6,10.15,20,25, 30 min after induction of anaesthesia
次要结局
- To measure common carotid cFT and assess its specificity, sensitivity(and predictive value for hypotension after general anesthesia)