Arterial Elastance: A Predictor of Hypotension Due to Anesthesia Induction

NCT05648643 | Completed

• 1 other identifier: ATADEK 2021-10/21
• Study Type: observational
• Target: 100
• Locations: 1 country
• Sites: 1

Brief Summary

Hypotension is very common during and after anesthesia induction. A prolonged fasting period, a patient's underlying comorbidities, a sympathetic blockade by anesthetic agents, vasodilation, a reduction in preload, and cardiac contractility can cause post-induction hypotension.1,2 The relationship of even short-term hypotension with myocardial damage, renal injury, and stroke has been shown in many studies; therefore, it is very important to provide stable anesthesia induction.3 In current anesthesia practice, we can only intervene when hypotension occurs. If we can identify patients who may experience hypotension during anesthesia induction before it occurs, we can prevent possible postoperative organ dysfunctions by reducing the duration and depth of hypotension with prophylactic fluid and vasopressor administration. We hypothesized that arterial elastance (Ea) values before anesthesia induction could predict post-induction hypotension. To test our hypothesis, we aimed to investigate the reliability of the Ea value, which was monitored preoperatively using the pressure analytical recording method (PRAM) to predict the risk of hypotension that may occur after anesthesia induction.

Conditions

Hemodynamic Instability; Anesthesia

Keywords

General anesthesia; Arterial elastance; Post-induction hypotension; Monitorization

Outcome Measures

Primary Outcomes (1)

• Arterial elastance (Ea) measured before anesthesia induction was investigated whether is a predictive parameter for post-induction hypotension in patients undergoing general anesthesia.

  Ea ((mmHg m-2ml-1)is an indicator of cardiac afterload and arterial tone and can be calculated by the ratio of the end-systolic pressure (ESP) and stroke volume (SV) obtained from arterial wave analysis. Ea was monitored using the uncalibrated pulse contour device MostCare (Vytech, Vygon, Padova, Italy) before the anesthesia induction

  The duration of the study was defined from one minute before induction to 10 minutes after induction

Secondary Outcomes (1)

• Stroke volume variation (SVV), measured before anesthesia induction were assessed for prediction of post-induction hypotension in patients undergoing general anesthesia

  The duration of the study was defined from one minute before induction to 10 minutes after induction

Other Outcomes (8)

• Pulse pressure variation (PPV), measured before anesthesia induction were assessed for prediction of post-induction hypotension in patients undergoing general anesthesia

  The duration of the study was defined from one minute before induction to 10 minutes after induction

• Cardiac power output (CPO), measured before anesthesia induction were assessed for prediction of post-induction hypotension in patients undergoing general anesthesia

  The duration of the study was defined from one minute before induction to 10 minutes after induction

• Cardiac index (CI), measured before anesthesia induction were assessed for prediction of post-induction hypotension in patients undergoing general anesthesia

  The duration of the study was defined from one minute before induction to 10 minutes after induction

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)
• Sampling Method: Non-Probability Sample

Study Population

patients with ASA physical status 1-3 who underwent major elective surgery

You may qualify if:

• Patients with ASA( American Society Of Anesthesiology) physical status 1-3
• Underwent major elective surgery
• Required intra-arterial blood pressure monitoring before induction.

You may not qualify if:

• Under 18 years of age
• Arrhythmia (atrial fibrillation, frequent premature beat)
• Severe pre-existing lung disease
• Severe valvular heart disease
• morbid obesity
• emergency surgery

Sponsors & Collaborators

• Acibadem University: lead

Study Sites (1)

Acibadem Altunizade Hospital

Istanbul, 31190, Turkey (Türkiye)

Location

Related Publications (3)

• Monge Garcia MI, Jian Z, Settels JJ, Hatib F, Cecconi M, Pinsky MR. Reliability of effective arterial elastance using peripheral arterial pressure as surrogate for left ventricular end-systolic pressure. J Clin Monit Comput. 2019 Oct;33(5):803-813. doi: 10.1007/s10877-018-0236-y. Epub 2018 Dec 14.

  PMID: 30552525 BACKGROUND

• Merillon JP, Ennezat PV, Guiomard A, Masquet-Gourgon C, Aumont MC, Gourgon R. Left ventricular performance is closely related to the physical properties of the arterial system: Landmark clinical investigations in the 1970s and 1980s. Arch Cardiovasc Dis. 2014 Oct;107(10):554-62. doi: 10.1016/j.acvd.2014.08.001. Epub 2014 Oct 8.

  PMID: 25304173 BACKGROUND

• Monge Garcia MI, Jian Z, Settels JJ, Hunley C, Cecconi M, Hatib F, Pinsky MR. Determinants of left ventricular ejection fraction and a novel method to improve its assessment of myocardial contractility. Ann Intensive Care. 2019 Apr 16;9(1):48. doi: 10.1186/s13613-019-0526-7.

  PMID: 30993544 BACKGROUND

Study Design

• Study Type: observational
• Observational Model: OTHER
• Time Perspective: PROSPECTIVE
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Medical doctor

Study Record Dates

• First Submitted: November 26, 2022
• First Posted: December 13, 2022
• Study Start: January 1, 2022
• Primary Completion: June 30, 2022
• Study Completion: August 15, 2022
• Last Updated: December 13, 2022

Record last verified: 2022-12

Data Sharing

• IPD Sharing: Will not share

Locations

TU (1)