Ability of Carotid Sonography and Inferior Vena Cava Sonography for the Prediction of Post-induction Hypotension in Hypertensive Patients

Study Overview
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Brief Summary
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Hypertensive patients have more hemodynamic instability during general anesthesia than do patients with NORMOTENSION. In this study, the investigators evaluated the usefulness of carotid ultrasound and inferior vena cervical ultrasound for predicting hypotension after induction of anesthesia in patients with hypertension.

Detailed Description
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Carotid and venous ultrasonography is performed in a comfortable state. Corrected blood flow after carotid ultrasound and carotid artery blood flow rate were measured. After inferior vena cava sonography, using the embedded software, the collapsibility Index by measuring the largest and smallest diameter during the respiratory cycle will be obtained. After confirming baseline blood pressure and pulse rate, propofol 2 mg / kg is administered and remifentanil is maintained at 4.0 ng / mL using the Target Control System (TCI). Following the administration of rocuronium 1.0-1.2 mg / kg, and 1 minute and 30 seconds after BIS 60 or less, endotracheal intubation is performed using video laryngoscope. Blood pressure and heart rate are measured at prior to induction, 1 minute after the induction, immediately after intubation, and at 1, 3, 5, 7 and 10 minutes after intubation. Post-induction hypotension after anesthesia induction is considered as a decrease of 20% or more of the pre-anesthesia blood pressure or a mean arterial blood pressure of less than 60 mmHg. In the event of hypotension in accordance with the above definition, repeated administration of ephedrine 4 mg or phenylephrine 50 mcg is used.

Official Title
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Ability of Carotid Sonography and Inferior Vena Cava Sonography for the Prediction of Post-induction Hypotension in Hypertensive Patients

Conditions
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General Anesthesia

Intervention / Treatment
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* Biological: carotid sonography and inferior vena cava sonography


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: 1) 19-80 years old hypertensive patients with ASA class I-III 2) Scheduled surgery under general anesthesia Exclusion Criteria: 1) Emergency operation 2) Reoperation 3) Patients with history of heart failure (unstable angina, congestive heart failure, coronary artery disease) 4) Patients under 40 % of Ejection faction 5) Patients with history of valvular heart failure 6) Patients with history of peripheral arterial occlusive disease 7) Patients with history of arrhythmia (specially AV nodal block), ventricular conduction problem 8) Pregnancy patients 9) Patients who cannot read the consent form (examples: Illiterate, foreigner) 10) Patients with history of uncontrolled psychiatric disease (PTSD, anxiety, depression) 11) Patients who withdraw the consent

Ages Eligible for Study
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Minimum Age: 19 Years
Maximum Age: 80 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| hypertensive group<br>Evaluation of the ability of carotid sonography and inferior vena cava sonography for the post-induction hypotension in hypertensive patients undergoing general anesthesia | Biological: carotid sonography and inferior vena cava sonography<br>* Carotid and venous ultrasonography is performed in a comfortable state. Corrected blood flow after carotid ultrasound and carotid artery blood flow rate were measured. After inferior vena cava sonography, the collapsibility Index by measuring the largest and smallest diameter during the respiratory cycle will be obtained. Propofol 2 mg / kg is administered and remifentanil is maintained at 4.0 ng / mL using the Target Control System. Blood pressure and heart rate are measured at prior to induction, 1 minute after induction, immediately after intubation, and at 1, 3, 5, 7 and 10 minutes after intubation. Post-induction hypotension is considered as a decrease of 20% or more of baseline blood pressure or a mean arterial blood pressure of less than 60 mmHg. In the event of hypotension in accordance with the above definition, repeated administration of ephedrine 4 mg or phenylephrine 50 mcg is used.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Prediction power of the post-induction hypotension of carotid sonography and inferior vena cava sonography | To evaluate the ability of carotid sonography and inferior vena cava sonography for the post-induction hypotension in hypertensive patients undergoing general anesthesia, blood pressure was measured 8 times below time points. | Prior to induction | 
| Prediction power of the post-induction hypotension of carotid sonography and inferior vena cava sonography | To evaluate the ability of carotid sonography and inferior vena cava sonography for the post-induction hypotension in hypertensive patients undergoing general anesthesia, blood pressure was measured 1 minute after anesthetic induction. | 1 minute after anesthetic induction | 
| Prediction power of the post-induction hypotension of carotid sonography and inferior vena cava sonography | To evaluate the ability of carotid sonography and inferior vena cava sonography for the post-induction hypotension in hypertensive patients undergoing general anesthesia, blood pressure was measured Immediately after intubation. | Immediately after intubation | 
| Prediction power of the post-induction hypotension of carotid sonography and inferior vena cava sonography | To evaluate the ability of carotid sonography and inferior vena cava sonography for the post-induction hypotension in hypertensive patients undergoing general anesthesia, blood pressure was measured 1 minute after tracheal intubation. | 1 minute after tracheal intubation | 
| Prediction power of the post-induction hypotension of carotid sonography and inferior vena cava sonography | To evaluate the ability of carotid sonography and inferior vena cava sonography for the post-induction hypotension in hypertensive patients undergoing general anesthesia, blood pressure was measured 3 minutes after tracheal intubation. | 3 minutes after tracheal intubation | 
| Prediction power of the post-induction hypotension of carotid sonography and inferior vena cava sonography | To evaluate the ability of carotid sonography and inferior vena cava sonography for the post-induction hypotension in hypertensive patients undergoing general anesthesia, blood pressure was measured 5 minutes after tracheal intubation. | 5 minutes after tracheal intubation | 
| Prediction power of the post-induction hypotension of carotid sonography and inferior vena cava sonography | To evaluate the ability of carotid sonography and inferior vena cava sonography for the post-induction hypotension in hypertensive patients undergoing general anesthesia, blood pressure was measured 7 minutes after tracheal intubation. | 7 minutes after tracheal intubation | 
| Prediction power of the post-induction hypotension of carotid sonography and inferior vena cava sonography | To evaluate the ability of carotid sonography and inferior vena cava sonography for the post-induction hypotension in hypertensive patients undergoing general anesthesia, blood pressure was measured 10 minutes after tracheal intubation. | 10 minutes after tracheal intubation | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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carotid sonography, inferior vena cava sonography, hypertension, general anesthesia, predictive power