Intestinal Obstruction, Post-induction Hypotension
Conditions
Keywords
Stroke Volume, Inferior Vena Cava Collapsibility Index, LVOT-VTI, Echocardiography, General Anesthesia
Brief summary
Postinduction hypotension (PIH) is a frequent complication during general anesthesia. This study aims to compare the predictive effectiveness and diagnostic accuracy of stroke volume (SV) measured via left ventricular outflow tract velocity time integral (LVOT-VTI) versus the inferior vena cava collapsibility index (IVC-CI) using transthoracic echocardiography. The assessment will be conducted in adult patients with intestinal obstruction undergoing exploratory abdominal surgery under general anesthesia.
Detailed description
Postinduction hypotension (PIH) is associated with adverse postoperative outcomes. In this diagnostic accuracy observational study, adult patients aged 40-70 years with intestinal obstruction undergoing exploratory abdominal surgery under general anesthesia will be enrolled at Ain Shams University Hospitals. Prior to induction of general anesthesia, transthoracic echocardiography (TTE) will be performed to measure the stroke volume (SV) via LVOT-VTI and the inferior vena cava collapsibility index (IVC-CI). Patients will receive standard rapid sequence induction, and hemodynamic parameters will be monitored post-induction to evaluate the predictive value, sensitivity, and specificity of SV versus IVC-CI for postinduction hypotension. Secondary outcomes including incidence of PIH, length of hospital stay, PACU recovery time, and postoperative nausea and vomiting will also be recorded.
Interventions
None listed
Sponsors
Ain Shams University
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
40 Years to 70 Years
Healthy volunteers
No
Inclusion criteria
* Adult patients with intestinal bowel obstruction undergoing exploratory abdominal surgery under general anesthesia. * Age 40 to 70 years old. * Body Mass Index (BMI) = 18 to 25 kg/m2. * American Society of Anesthesiologists (ASA) physical status grade I or II.
Exclusion criteria
* American Society of Anesthesiologists (ASA) physical status grade \>= III. * Patients in whom the IVC cannot be visualized or patients with poor echogenicity. * Patients with hemodynamic instability. * Patients with vascular, respiratory, or cardiac diseases (e.g., cardiomyopathy, heart valve disease, arrhythmia, or bad exercise tolerance). * Pregnant patients. * Difficult airway or multiple intubatio
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Diagnostic accuracy of Stroke Volume (SV) to predict post-induction hypotension. | Baseline (pre-induction) and immediately post-induction. | Area under the receiver operating characteristic curve (AUC) of stroke volume measured via left ventricular outflow tract velocity-time integral (LVOT-VTI) as a predictor of post-induction hypotension. |
| Diagnostic accuracy of Inferior Vena Cava Collapsibility Index (IVC-CI) to predict post-induction hypotension. | Baseline (pre-induction) and immediately post-induction. | Area under the receiver operating characteristic curve (AUC) of inferior vena cava collapsibility index measured via transthoracic echocardiography (TTE) as a predictor of post-induction hypotension. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Incidence of Post-Induction Hypotension | Within 3 minutes following induction of general anesthesia. | Assessment of the proportion of patients who develop post-induction hypotension, defined as SBP decrease \> 30%, MAP decrease \> 20% from baseline, or absolute SBP \< 90 mmHg and MAP \< 60 mmHg. |
| Length of Hospital Stay Length of Hospital Stay | From date of surgery until hospital discharge (up to 9 months). | Total duration of hospitalization from the day of surgery until discharge. |
| Time to Recovery from Post-Anesthesia Care Unit (PACU) Time to Recovery from Post-Anesthesia Care Unit (PACU) | Intraoperative / immediate postoperative period until PACU discharge (up to 24 hours). | Time elapsed from patient admission to the PACU until meeting discharge criteria. Time elapsed from patient admission to the PACU until meeting discharge criteria. |
Contacts
CONTACTNoura A Kamal, M.Sc.
CONTACTIslam A Taher, M.D.
STUDY_CHAIRMohamed H Shokeir, M.D., Ph.D.
Ain Shams University
Outcome results
None listed