Hypotension on Induction
Conditions
Keywords
Hypovolemia, Pulse Wave Analysis, Hypotension, Anesthesia, General
Brief summary
The aim of this study is to investigate whether the change in pleth variation index (PVI) according to preoxygenation can predict hypotension during anesthesia induction.
Detailed description
In patients with hypovolemia or dehydration, pulse pressure variation can be increased by spontaneous forced inspiratory breathing. PVI is a noninvasive method of indicator of fluid responsiveness like purse pressure variation. We expected that the amount of change in PVI between at the time of entering operating room and after preoxygenation with forced inspiration method could be different depending on the patient's volume status. After entering operating room, monitoring devices, anesthesia depth sensor, and Radical-7® Pulse CO-Oximeter® are attached. Patients rest for 5 minutes, and then baseline systolic blood pressure, diastolic blood pressure, mean blood pressure, and heart rate are collected every 1-minute. Pleth variability index (PVI), perfusion index (PI) are also measured continuously. For pre-oxygenation of anesthesia, take 8 deep breaths at flow 10 l/min of 100% oxygen for 1 minute with maximally forced inspiration. After that, for 2 minutes, patients breathe as usual while maintaining oxygen supply. until tracheal intubation or laryngeal mask insertion. Anesthesia is induced with target concentration infusion of 4.0 ng/ml of remifentanil and 4.0 ug/ml of propofol. When the patient loses consciousness, rocuronium 1.0 mg/kg is administrated and endotracheal tube or laryngeal mask is inserted 2 minutes after. PVI, PI, blood pressure, and heart rate are measured until tracheal intubation or laryngeal mask insertion. Anesthesia induction-related hypotension is defined as a decrease in mean arterial pressure below 60 mmHg at any timepoint from baseline parameter collection to until airway device insertion. The parameters are analyzed by comparing between groups with and without anesthesia induction-related hypotension.
Interventions
PROCEDUREPreoxygenation
Taking 8 deep breaths at 10 l/min of 100% oxygen for 1 minute with forced inspiration for pre-oxygenation
Sponsors
GEMSKOREA
Seoul National University Hospital
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
SCREENING
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
19 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Adult patients undergoing elective surgery under general anesthesia
Exclusion criteria
* (1) American Society of Anesthesiologists (ASA) physical status classification III or higher (2) Patients with cognitive impairment who are unable to follow instructions (3) Patients with pulmonary dysfunction (4) Other patients who are judged inappropriate to the experiment by the researcher
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Hypotension during anesthesia induction | from start of anesthesia induction to just before intubation | When mean blood pressure decreases to less than 60 mmHg at least once from the administration of anesthetic agent to just before intubation |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Diastolic blood pressure | from entering operating room to just before intubation | diastolic blood pressure with non-invasive blood pressure at 1-minute intervals. |
| Heart rate | from entering operating room to just before intubation | heart rate which was measured continuously. |
| Perfusion index | from entering operating room to just before intubation | Perfusion index from Radical-7® Pulse CO-Oximeter® which was measured continously. |
| Systolic blood pressure | from entering operating room to just before intubation | systolic blood pressure with non-invasive blood pressure at 1-minute intervals. |
| Pleth Variability Index (PVi®) | from entering operating room to just before intubation | the relative variability of the pleth waveform (perfusion index) detected from a Radical-7® Pulse CO-Oximeter® |
| Saturation of percutaneous oxygen | from entering operating room to just before intubation | from a Radical-7® Pulse CO-Oximeter® |
| Pulse oximetry plethysmographic waveform; ΔPOP | from the administration of anesthetic agent to just before intubation | Respiratory variations in the pulse oximetry plethysmographic waveform amplitude |
Countries
South Korea
Contacts
Primary ContactYoon Jung Kim
Outcome results
None listed