General Anesthesia With Propofol, Hypotension on Induction, Intraoperative Hypotension, Jugular Veins
Conditions
Keywords
Post-induction Hypotension, Internal Jugular Vein, Collapsibility Index, Propofol Induction, Acute Kidney Injury
Brief summary
This observational study aims to learn whether changes in the internal jugular vein during anesthesia induction can help predict low blood pressure and kidney injury after surgery. The main questions it aims to answer are: 1. Can the internal jugular vein collapsibility index before anesthesia predict low blood pressure during induction? 2. Can the change in internal jugular vein collapsibility from before to just after anesthesia predict low blood pressure during surgery and acute kidney injury after surgery? Participants will have routine ultrasound scans of the neck before anesthesia and again shortly after they fall asleep for surgery. Researchers will also record blood pressure during surgery and measure kidney function after surgery using routine blood tests. and again shortly after they fall asleep for surgery. Researchers will also record blood pressure during surgery and measure kidney function after surgery using routine blood tests.
Detailed description
This is a single-centre prospective observational study of adults undergoing major abdominal or visceral surgery under general anesthesia. The study is designed to see whether bedside ultrasound measurements of the internal jugular vein can help identify participants who are at risk of low blood pressure during anesthesia induction and acute kidney injury after surgery. Participants will have one ultrasound scan while awake before anesthesia and a second scan shortly after loss of consciousness following propofol induction. The researchers will calculate the internal jugular vein collapsibility index from both scans and determine the change between them. They will then compare these measurements with blood pressure changes during the induction period and with postoperative kidney function, which will be assessed using routine creatinine tests. The study includes adults aged 18 years and older who are having elective or urgent non-emergency major abdominal or visceral surgery. Participants must receive propofol for anesthesia induction and must have blood pressure monitoring during surgery. People with emergency surgery, dependence on dialysis, major anatomic abnormalities that prevent ultrasound scanning of the neck, or other conditions that would invalidate the ultrasound measurement will not be included. The study does not change routine anesthesia care. The ultrasound scans and blood tests are added only for research purposes, and the results are intended to help predict risk rather than guide treatment during the study itself.
Interventions
PROCEDUREInternal Jugular Vein Ultrasound Assesment
Point-of-care Internal jugular vein ultrasound performed before induction and immediately after propofol induction to measure vein diameter and collapsibility index.
Sponsors
Tîrgu Mureș Emergency Clinical County Hospital, Romania
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
* Elective or Urgent (Non-emergent) major abdominal/ visceral surgery under general anesthesia * General anesthesia with propofol induction (TCI/ manual) * Expected surgical duration \> 60 minutes * Continous BP monitoring (Invasive arterial line or non-invasive cuff at 2 minute recording intervals) * Serum creatinine and eGFR (CKD-EPI) available within 30 days prior to surgery * Written informed consent obtained before surgery * Patient accessible by phone 30 days postoperatively
Exclusion criteria
* Emergency surgery (immediate life-saving, consent unobtainable) * End-stage renal disease (eGFR \< 15 mL/min/1.73 m²) or dialysis-dependent * Concomitant cardiac surgery or carotid endarterectomy * Liver transplantation * Known Internal Jugular Vein/ Inferior Vena Cava thrombosis or Superior Vena Cava syndrome * Any anatomical neck abnormalities precluding Internal jugular vein ultrasound * Induction with ketamine or etomidate as sole Induction agent * Neuraxial anesthesia (spinal or epidural) before propofol induction * Active decompensated heart failure (NYHA IV or acute pulmonary edema at time of Surgery) * Same-admission reoperation within 30-day study window * Withdrawal of consent at any point
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Post-induction hypotension | Periprocedural | Incidence of mean arterial pressure below 65 mmHg for atleast one consecutive minute during propofol induction |
| Change in Internal Jugular Vein Collapsibility Index | From pre-induction to immediate post-induction | Difference between pre-induction and immediate post-induction internal jugular vein collapsibility index measured by point-of-care ultrasound |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Postoperative Acute Kidney Injury | Postoperative days one to three | Acute Kidney Injury defined according to KDIGO criteria based on postoperative serum creatinine measurements |
| Cumulative Intra-operative Hypotension Burden | Induction to End of Surgery | Total duration of mean arterial pressure threshold of 65 mmHg during the operative period |
Countries
Romania
Outcome results
None listed