Anesthesiology Hypotension
Conditions
Interventions
Patients:
Cohort 1 (first 50 patients): management of hypotension as usual.
Cohort 2 (second 50 patients): management of hypotension keeping the MAP >65.
Cohort 3 (third 50 patients): management of
Sponsors
None listed
Eligibility
Inclusion criteria
Inclusion criteria: • Patients due to undergo elective major abdominal, orthopedic, head and neck or vascular surgery requiring invasive arterial monitoring (decided at the discretion of the treating clinician) under general anesthesia with positive pressure ventilation, and with an expected duration of greater than 90 minutes, who will have goal directed fluid therapy performed as part of their standard care.
Exclusion criteria
Exclusion criteria: • Requirement for an intentional intraoperative MAP of less than 65 mmHg as decided by the treating surgeon and/or anesthetist. • A preoperative MAP of lower than 65 mmHg documented on 2 separate occasions at preoperative assessment clinic. • Patients with significant right or left ventricular failure • Patients with known intra cardiac shunt. • Patients with known severe aortic stenosis (peak velocity greater than 4 meter per second and/or aortic valve area less than 1 cm2) • Patients with known cardiac arrhythmias • Planned positive pressure ventilation with tidal volume < 7 ml/kg • Patients undergoing hepatic surgery • Patients requiring dialysis. • Patients who do not have the capacity to consent • Patients aged less than 18 years of age.
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| A range of social-cognitive determinants of behaviour change including attitudes, self-efficacy, social norms, skills, as well as factors relating to the normalisation of technology into routine practice through qualitative data analysis. | — |
Secondary
| Measure | Time frame |
|---|---|
| Description of treatment of hypotension. Incidence of hypotension defined as number of episodes with MAP <65 mmHg. Time weighted average spent in hypotension. Change in the amount of fluid and dose and type of vasopressors/inotropes given. Proportion of interventions deemed suboptimal to treat hypotension compared to the cohort 3 treatment protocol. Effects of interventions (fluid, vasopressors and inotropes) on secondary variables including SVV, PPV, CI, SVI, Eadyn and dP/dT. | — |
Contacts
Public ContactR. Spanjersberg
Hanzeplein 1
Outcome results
None listed