Aged, Hypotension, Spinal Anesthesia, Urologic Neoplasms
Conditions
Brief summary
Spinal anesthesia-induced hypotension is a common and clinically significant complication in elderly patients undergoing oncologic surgery. Early identification of patients at risk for hemodynamic instability remains a major challenge in perioperative management. Skin conductance reflects sympathetic nervous system activity and may provide a noninvasive indicator of autonomic responses. This prospective observational study aims to evaluate whether skin conductance measurements can predict the development of hypotension following spinal anesthesia in geriatric oncology patients undergoing urologic surgery. The findings may contribute to improved perioperative monitoring and early risk stratification in this vulnerable patient population.
Detailed description
Spinal anesthesia is widely used in urologic oncology surgery due to its favorable analgesic profile and reduced systemic anesthetic exposure. However, spinal anesthesia frequently leads to significant hemodynamic changes, particularly hypotension, which is more pronounced in elderly patients because of age-related alterations in autonomic regulation, reduced cardiovascular reserve, and increased comorbidity burden. Spinal anesthesia-induced hypotension may result in inadequate tissue perfusion and increased perioperative morbidity, making early identification of patients at risk an important aspect of perioperative management. Skin conductance is a noninvasive physiological parameter reflecting sympathetic nervous system activity and sudomotor responses. Changes in skin conductance have been associated with variations in autonomic nervous system activity and may provide an indirect indicator of hemodynamic responses. Continuous monitoring of skin conductance may therefore offer a potential method for identifying patients who are more likely to develop hypotension after spinal anesthesia. The aim of this prospective observational study is to investigate the relationship between skin conductance measurements and the development of hypotension following spinal anesthesia in geriatric oncology patients undergoing urologic surgery. Hemodynamic parameters including blood pressure and heart rate will be monitored perioperatively, and their association with skin conductance measurements will be evaluated. The results of this study may contribute to improving perioperative monitoring strategies and risk prediction in elderly oncology patients undergoing spinal anesthesia.
Interventions
OTHERSkin Conductance Monitoring
Skin conductance will be continuously monitored using a noninvasive electrodermal activity monitoring device to assess sympathetic nervous system activity during the perioperative period. Measurements will be recorded before and after spinal anesthesia and evaluated in relation to the development of spinal anesthesia-induced hypotension.
Sponsors
Dr Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
65 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Patients aged 65 years and older * Patients scheduled for elective urologic oncology surgery under spinal anesthesia * American Society of Anesthesiologists (ASA) physical status I-III * Patients who provide written informed consent to participate in the study
Exclusion criteria
* Refusal to participate or inability to provide informed consent * Contraindication to spinal anesthesia (e.g., infection at puncture site, coagulopathy) * Severe cardiac conduction abnormalities or presence of a cardiac pacemaker * Severe autonomic dysfunction or known neuropathy affecting autonomic responses * Use of medications that significantly affect autonomic nervous system activity * Baseline hypotension or hemodynamic instability before spinal anesthesia * Inability to obtain reliable skin conductance measurements (e.g., severe skin lesions at electrode placement site)
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Number of Participants with Spinal Anesthesia-Induced Hypotension | From initiation of spinal anesthesia until 20 minutes after spinal anesthesia. | The number of participants who experience hypotension, defined as a decrease in mean arterial pressure (MAP) of ≥20% from baseline or a MAP \<65 mmHg, within 20 minutes after spinal anesthesia. Time Frame: From initiation of spinal anesthesia until 30 minutes after spinal anesthesia. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Incidence of Bradycardia After Spinal Anesthesia | From initiation of spinal anesthesia until 20 minutes after spinal anesthesia | The number of participants who experience bradycardia, defined as a heart rate of less than 50 beats/min, within 20 minutes after spinal anesthesia. |
| Maximum Percentage Decrease in Mean Arterial Pressure (MAP) | From initiation of spinal anesthesia until 20 minutes after spinal anesthesia. | The maximum percentage drop in MAP from the baseline value recorded for each participant during the observation period. |
| Number of Participants Requiring Vasopressor Administration | From initiation of spinal anesthesia until 20 minutes after spinal anesthesia. | The number of participants who require at least one dose of vasopressor (e.g., ephedrine or phenylephrine) to treat hypotension according to the study protocol. |
| Changes in Skin Conductance Values | From baseline measurement before spinal anesthesia until 20 minutes after spinal anesthesia | The average change in the number of skin conductance fluctuations (peaks per second) from baseline to the point of maximum hemodynamic change. |
Countries
Turkey (Türkiye)
Outcome results
None listed