Target-controlled Infusion Anesthesia and Post-induction Hypotension
Condition: General Anesthesia; Hemodynamic Instability
MeSH terms: Hypotension
Study type: Interventional

Summary: 
      Hemodynamic changes during induction of anesthesia may have adverse outcomes and should
      therefore be avoided. The decrease in blood pressure during induction of anesthesia with
      propofol is due to a decrease in systemic vascular resistance or cardiac output and may be
      increased by the concomitant use of other drugs such as remifentanil. Target controlled
      infusion (TCI) system aims to reach the theoretically targeted blood or brain concentration
      of anesthetic agents based on the patient's age, weight, and height, with computer-assisted
      algorithms. In manual anesthesia induction, anesthetic agents are administered at a fixed
      dose and rate adjusted according to the patient's weight, which may cause hypotension in
      patients with low cardiovascular performance. As target-controlled infusion (TCI) obviates
      the need to calculate the infusion rate manually, the use of TCI may provide a better
      hemodynamic profile during anesthesia induction This study was designed to test the
      hypothesis that propofol by TCI anesthesia induction is associated with a lower hypotension
      rate when compared with manual anesthesia induction
    

Detailed description: 
      Maintaining normotension is one of the top priorities for anesthesiologists due to its
      negative effects. Although there are a lot of studies and knowledge on the topic
      approximately 20-30% of patients develop post-induction hypotension. Mostly it occurs due to
      the adverse effects of anesthetics such as a decrease in systemic vascular resistance or
      cardiac output and the interplay between them. The risk can be minimized in two steps: first
      by identifying high-risk patients, and second with tight control of hemodynamic parameters.
      As a second step, tight hemodynamic control during induction may be done using
      target-controlled infusion (TCI) systems, which systems help to adjust the dosage to the
      needs of each patient by measuring hypnotic effects through the bispectral index (BIS).

      TCI models for propofol have been previously compared with manual infusions, however, it is
      not clear whether it still contributes to or triggers hemodynamic deterioration. Therefore in
      this study, the investigators' aim is to determine the effect of two different anesthesia
      techniques on the development of postinduction hypotension through hemodynamic parameters
      monitored by the pressure recording analytical method (PRAM). The secondary aim is to
      identify risk factors that can predict postinduction hypotension
    

Intervention name(s): Manual anesthesia induction; Anesthesia induction with Target controlled infusions (TCI)
Intervention type(s): Other; Other
Intervention description(s): In manual anesthesia induction, anesthetic agents are administered at a fixed dose and rate adjusted according to the patient's weight; Target controlled infusion (TCI) system aims to reach the theoretically targeted blood or brain concentration of anesthetic agents based on the patient's age, weight, and height, with computer-assisted algorithms.
Other intervention name(s): Manuel induction; TCI induction
Intervention MeSH terms: Anesthetics
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Single-center, prospective, non-blinded, randomized controlled trial, Patients were allocated to 2 groups:
Group 1 Patients who underwent anesthesia induction with target-controlled infusion, Group 2: Patients who underwent manual anesthesia induction
Masking: None (Open Label)
Primary purpose: Screening
Keywords: General anesthesia; Target controlled infusion; Post-induction hypotension; Monitoring