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

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

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.

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.

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