Hemodynamic Effects of Lithotomy Position in Surgical Patients (PH-LITHO)

NCT07549152 | Completed

• 2 other identifiers: KTU-PIH-2021Karadeniz Technical University
• Study Type: interventional
• Target: 60
• Locations: 1 country
• Sites: 1

Brief Summary

Anesthesia-induced hypotension is a common occurrence in elderly hypertensive patients and is closely associated with increased postoperative morbidity

• This study aims to investigate whether the lithotomy position, a non-pharmacological and cost-free approach, can reduce the incidence of post-induction hypotension (PIH) in this high-risk population by increasing venous return Sixty patients aged 65-80 with a history of hypertension were randomly assigned to either the Supine Group (Group S) or the Lithotomy Group (Group L)
• In Group L, patients were placed in the lithotomy position 120 seconds before the start of anesthesia induction
• Blood pressure was monitored every minute for the first five minutes following induction
• The study evaluates whether this simple positioning strategy can maintain hemodynamic stability, reduce the drop in mean arterial pressure, and decrease the overall need for vasopressor medications like ephedrine

Conditions

Post-induction Hypotension (PIH); Hypertension (HTN); Geriatric Anesthesia

Keywords

Lithotomy position; Anesthesia Induction; Hemodynamic stability; Patient Positioning; Geriatric; General Anesthesia

Outcome Measures

Primary Outcomes (1)

• Incidence of Post-induction Hypotension (PIH)

  Post-induction hypotension is defined as a Mean Arterial Pressure (MAP) falling below 65 mmHg or a decrease of more than 20% from the baseline value

  Within the first 5 minutes following the completion of anesthesia induction (measurements recorded at minutes 0, 1, 2, 3, 4, and 5)

Secondary Outcomes (1)

• Time to Onset of First Hypotension

  Within the first 5 minutes after anesthesia induction

Study Arms (2)

Group S (Supine Position Group)

ACTIVE COMPARATOR

Patients in this group undergo anesthesia induction in the standard supine position

Other: Standard Supine Position

Group L (Lithotomy Position Group

EXPERIMENTAL

Patients in this group are placed in the lithotomy position before the start of anesthesia induction to evaluate its effect on hemodynamic stability

Other: Pre-induction Lithotomy Position

Interventions

Pre-induction Lithotomy Position OTHER

Patients are moved to the lithotomy position 120 seconds prior to the start of anesthesia induction to increase venous return * Following this 120-second interval in the lithotomy position, anesthesia is induced with intravenous midazolam (0.05 mg/kg), fentanyl (1 µg/kg), and thiopental (3-5 mg/kg) * All inductions are performed at a constant rate over 120 seconds * Post-induction hypotension (defined as MAP \< 65 mmHg or \>20% drop from baseline) is treated with 5 mg of intravenous ephedrine

Group L (Lithotomy Position Group

Standard Supine Position OTHER

Patients remain in the standard supine position for a 3-minute rest period before induction begins * General anesthesia is induced using the same protocol as the experimental group: intravenous midazolam (0.05 mg/kg), fentanyl (1 µg/kg), and thiopental (3-5 mg/kg) administered over a period of 120 seconds * Hypotension (defined as MAP \< 65 mmHg or \>20% drop from baseline) is managed with 5 mg of intravenous ephedrine as rescue therapy

Also known as: Supine Position, Group S

Group S (Supine Position Group)

Eligibility Criteria

• Age: 65 Years - 80 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Older Adult (65+)

You may qualify if:

• Aged between 65 and 80 years.
• American Society of Anesthesiologists (ASA) physical status class II or III.
• Clinical diagnosis of hypertension.
• Continuous use of the same antihypertensive medication for at least 6 months.
• Scheduled for elective surgery requiring the lithotomy position.

You may not qualify if:

• Uncontrolled hypertension.
• Arrhythmias requiring medical treatment.
• Left ventricular ejection fraction (LVEF) \< 40%.
• Unstable ischemic heart disease.
• Physical inability to be placed in the lithotomy position.

Sponsors & Collaborators

• Trabzon Karadeniz Teknik Universitesi: lead

Study Sites (1)

Karadeniz Technical University Faculty of Medicine

Trabzon, Kalkınma, 61100, Turkey (Türkiye)

Location

Related Publications (5)

• Miyabe M, Sonoda H, Namiki A. The effect of lithotomy position on arterial blood pressure after spinal anesthesia. Anesth Analg. 1995 Jul;81(1):96-8. doi: 10.1097/00000539-199507000-00019.

  PMID: 7598290 BACKGROUND

• Kweon TD, Jung CW, Park JW, Jeon YS, Bahk JH. Hemodynamic effect of full flexion of the hips and knees in the supine position: a comparison with straight leg raising. Korean J Anesthesiol. 2012 Apr;62(4):317-21. doi: 10.4097/kjae.2012.62.4.317. Epub 2012 Apr 23.

  PMID: 22558496 BACKGROUND

• Fakhari S, Bilehjani E, Farzin H, Pourfathi H, Chalabianlou M. The effect of passive leg-raising maneuver on hemodynamic stability during anesthesia induction for adult cardiac surgery. Integr Blood Press Control. 2018 Jun 7;11:57-63. doi: 10.2147/IBPC.S126514. eCollection 2018.

  PMID: 29922085 BACKGROUND

• Reich DL, Hossain S, Krol M, Baez B, Patel P, Bernstein A, Bodian CA. Predictors of hypotension after induction of general anesthesia. Anesth Analg. 2005 Sep;101(3):622-628. doi: 10.1213/01.ANE.0000175214.38450.91.

  PMID: 16115962 BACKGROUND

• Sudfeld S, Brechnitz S, Wagner JY, Reese PC, Pinnschmidt HO, Reuter DA, Saugel B. Post-induction hypotension and early intraoperative hypotension associated with general anaesthesia. Br J Anaesth. 2017 Jul 1;119(1):57-64. doi: 10.1093/bja/aex127.

  PMID: 28974066 BACKGROUND

MeSH Terms

Conditions

Hypertension

Interventions

Supine Position

Condition Hierarchy (Ancestors)

Vascular Diseases; Cardiovascular Diseases

Intervention Hierarchy (Ancestors)

Posture; Musculoskeletal Physiological Phenomena; Musculoskeletal and Neural Physiological Phenomena

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: OUTCOMES ASSESSOR
• Masking Details: Researchers involved in hemodynamic data recording and statistical analysis were blinded to the group assignments
• Purpose: PREVENTION
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Research Assistant, Department of Anesthesiology and Reanimatio

Study Record Dates

• First Submitted: April 17, 2026
• First Posted: April 23, 2026
• Study Start: March 1, 2021
• Primary Completion: January 31, 2022
• Study Completion: January 31, 2022
• Last Updated: April 29, 2026

Record last verified: 2026-04

Data Sharing

• IPD Sharing: Will not share

Locations

TU (1)