Clinical trial NCT06679933: Relationship Between Grip Strength and Intraoperative Hemodynamic Parameters
Official title: Relationship Between Grip Strength and Intraoperative Hemodynamic Parameters in Geriatric Patients Undergoing Spinal Anesthesia
Study type: OBSERVATIONAL
Overall status: COMPLETED
Conditions: Hypotension During Surgery
Geriatric Patient
Hand Grip Strength
Keywords: Geriatric Anesthesia
Hang Grip Strength
Intraoperative Hypotension
Spinal Anesthesia
Lead sponsor: Kirsehir Ahi Evran Universitesi
Sponsor class: OTHER
First posted: 2024-11-08
Enrollment: 105
Sex: ALL
Minimum age (years): 65
Standard ages: OLDER_ADULT
Accepts healthy volunteers: no
Observational model: COHORT
Time perspective: PROSPECTIVE
Sampling method: NON_PROBABILITY_SAMPLE
Study population: Male and female patients over the age of 65 with an ASA score of 1-3 who underwent elective surgery in our hospital (Kırşehir Research and Education Hospital) were included in the study. Patients were selected and included in the study during preoperative evaluation at the anesthesia clinic.

Brief summary: In geriatric anesthesia, hand grip strength is used as an important biomarker to evaluate the general health status of elderly patients. Hand grip strength is considered an indicator of various factors, such as muscle function, physical endurance, nutritional status, and frailty, and can be helpful in geriatric anesthesia practice to predict patients' response to anesthesia and determine their risk.

Hand grip strength is used as an important parameter in the pre-anesthesia evaluation of elderly patients. Low grip strength has been associated with postoperative complications (e.g., infection, pulmonary complications, prolonged hospitalization) and worse outcomes.Weak hand grip strength is related to the patient's degree of frailty. Frail patients may be less resistant to stress and respond more negatively to anesthesia.

One of the most important of these responses is intraoperative hypotension, and it is especially common in elderly patients. Since hypotension has possible adverse effects in the postoperative period, it is necessary to evaluate elderly patients in more detail during the preoperative evaluation in order to predict this and take the necessary precautions. Hand grip strength has been found to be associated with cardiovascular system health. With this study, the investigators wanted to evaluate whether measuring hand grip strength during preoperative evaluation would help evaluate the risk of intraoperative hypotension.

Detailed description: One of the most common intraoperative complications following spinal anesthesia is hypotension, which can occur in 16-33% of patients. In non-cardiac surgeries, there is a significant increase in postoperative major cardiac and cerebrovascular events within 30 days, parallel to the decrease in intraoperative mean arterial pressure within hypotensive limits. While there are different threshold values related to mean arterial pressure that can lead to organ damage in the literature, high-quality studies have found this value to be approximately 65 mmHg. However, in elderly patient groups, hypertension is frequently seen due to age-related arterial degeneration, which raises the perfusion thresholds of vital organs. In this context, rather than using a fixed threshold value, the variation of mean arterial pressure may provide a healthier perspective.

The risk of hypotension increases with physiological changes in the elderly, and the more widespread use of spinal anesthesia compared to general anesthesia in older adults underscores the need for better identification of risk factors.

Hand grip strength is a frequently used muscle strength measurement method in sports medicine and geriatric patient groups. It is usually measured in kg or lb with the help of a dynamometer. It provides valuable information in both rehabilitation studies and sarcopenia evaluation. Sarcopenia, or muscle wasting, is associated with frailty in geriatric patients and is one of the important indicators of cardiovascular health. For this reason, the deterioration of cardiovascular health with aging and the increase in the risk of hypotension, one of the side effects of anesthesia, can be predicted by muscle strength evaluation. The aim of our study is to examine whether muscle strength assessment is associated with intraoperative hypotension.

Eligibility criteria: Inclusion Criteria:

* Patients who are 65 years and older
* Patients undergoing elective surgery
* Patients suitable for spinal anesthesia

Exclusion Criteria:

* Presence of anatomical or neurological dysfunction of the upper extremity
* Failed spinal anesthesia
* Failure to measure hand grip strength accurately

Primary outcomes:
measure: Is low grip strength related with more hypotension?
timeFrame: During the surgery
Secondary outcomes:
measure: Is there any difference in blood pressure changes between patients with low hand grip strength and patients with high hand grip strength.
timeFrame: During the surgery
Other outcomes:
Locations:
city: Kırşehir
country: Turkey
facility: Kırşehir Ahi Evran University Research and Education Hospital
state: Kırsehir
Study officials:
References:
citation: Gregory A, Stapelfeldt WH, Khanna AK, Smischney NJ, Boero IJ, Chen Q, Stevens M, Shaw AD. Intraoperative Hypotension Is Associated With Adverse Clinical Outcomes After Noncardiac Surgery. Anesth Analg. 2021 Jun 1;132(6):1654-1665. doi: 10.1213/ANE.0000000000005250.
citation: Carpenter RL, Caplan RA, Brown DL, Stephenson C, Wu R. Incidence and risk factors for side effects of spinal anesthesia. Anesthesiology. 1992 Jun;76(6):906-16. doi: 10.1097/00000542-199206000-00006.