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This thesis aims to evaluate the ability of preoperative plethysmographic variability index to predict post-induction hypotension in comparison with ultrasound measurements of inferior vena cava (IVC) diameter.
Prospective cohort study. Upon arrival to the operating room, routine monitors (ECG, pulse oximetry, and non-invasive blood pressure monitor) will be applied, intravenous line will be secured and routine premedications (ranitidine 50 mg and ondansteron 4mg) will be administrated.
Then inferior vena cava ultrasonography will be performed. Maximum and minimum IVC diameters over a single respiratory cycle will be measured using built-in software. The CI will be calculated as: CI = (dIVCmax - dIVCmin)/dIVCmax , it will be expressed as a percentage.
Plethysmographic variability index and a perfusion index readings will be taken preinduction in the form of three readings on one-minute interval.
Induction of anaesthesia will be achieved using propofol (2 mg/Kg) and atracurium (0.5 mg/Kg). Endotracheal tube will be inserted after 3 minutes of mask ventilation.
Anaesthesia will be maintained by isoflurane (1-1.5%) and atracurium 10 mg increments every 20 minutes. Ringer lactate solution will be infused at a rate of 2 mL/Kg/hour.
Any episode of hypotension (defined as mean arterial pressure < 80% of the baseline reading) will be managed by 5mcg norepinephrine.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| study group | Participants will be adult patients (above 18 years), ASA I-II-III, scheduled for elective surgeries under general anesthesia. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| IVC Ultrasonography | Device | Ultrasound measurements will be performed using a curved transducer set to abdominal mode (1-5 MHz; Acuson x300; Siemens Healthcare, Seoul, Korea). IVC variation will be assessed using ultrasound in the long-axis (sagittal) view. IVC diameter will be measured 1 cm distal to its junction with hepatic vein either by 2-D or M modes via a subcostal approach according to the methodology described by the American Society of Echocardiography . A two-dimensional image of the IVC as it enters the right atrium will be first obtained. |
| Measure | Description | Time Frame |
|---|---|---|
| Comparison of the accuracy (Area under receiver operating characteristic curves) of PVI and IVC variation in prediction of post-induction hypotension | Maximum and minimum IVC diameters over a single respiratory cycle will be measured using a built-in software. The CI will be calculated as: CI = (dIVCmax - dIVCmin)/dIVCmax CI will be expressed as a percentage | 10 minutes before general anesthesia |
| Measure | Description | Time Frame |
|---|---|---|
| Plethysmographic variability index (PVI) and a perfusion index readings (PI) | Three readings, on one-minute interval before general anesthesia induction | 3 minutes |
| Maximum and minimum IVC diameters |
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Inclusion Criteria:
Exclusion Criteria:
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Participants will be adult patients (above 18 years), ASA I-II-III, scheduled for elective surgeries under general anaesthesia.
| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Bassant abdelhamid, M.D. | Contact | 01224254012 | bassantmohamed197@yahoo.com | |
| Akram Yassin, MS | Contact | 010 95 91 71 95 | Akram.yassin90@gmail.com |
| Name | Affiliation | Role |
|---|---|---|
| Bassant abdelhamid, M.D. | Cairo University | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Kasr alainy | Recruiting | Cairo | 1772 | Egypt |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 30236233 | Background | Wesselink EM, Kappen TH, Torn HM, Slooter AJC, van Klei WA. Intraoperative hypotension and the risk of postoperative adverse outcomes: a systematic review. Br J Anaesth. 2018 Oct;121(4):706-721. doi: 10.1016/j.bja.2018.04.036. Epub 2018 Jun 20. | |
| 26771910 | Background | Zhang J, Critchley LA. Inferior Vena Cava Ultrasonography before General Anesthesia Can Predict Hypotension after Induction. Anesthesiology. 2016 Mar;124(3):580-9. doi: 10.1097/ALN.0000000000001002. |
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| Plethysmographic variability index (PVI) and perfusion index readings (PI) | Device | The PVI and PI will be recorded in the supine position by an anaesthesiologist who was not involved in the further intraoperative monitoring of the patient using Masimo SET ("MightySat 9900, Masimo Corporation, Irvine, CA, USA). PVI (%) is a measure of the dynamic change in PI that occurs during one or more complete respiratory cycles, calculated as: PVI= [(PImax-PImin)/PImax] x100 |
|
Maximum and minimum IVC diameters over a single respiratory cycle will be measured using built-in software. The CI will be calculated as:
CI = (dIVCmax - dIVCmin)/dIVCmax , it will be expressed as a percentage.
| 10 minutes |
| Mean arterial blood pressure | measured at 1-minute intervals starting from the baseline preoperative reading until skin incision as follows: preinduction reading - 1-minute postinduction reading - 2-minute postinduction reading - preintubation reading - one-minute postintubation reading until skin incision | 20 minutes |
| Heart rate | measured at 1-minute intervals starting from the baseline preoperative reading until skin incision as follows: preinduction reading - 1-minute postinduction reading - 2-minute postinduction reading - preintubation reading - one-minute postintubation reading until skin incision | 20 minutes |
| Almaza Militrary Hospital | Recruiting | Cairo | Egypt |
|
| 20236098 | Background | Tsuchiya M, Yamada T, Asada A. Pleth variability index predicts hypotension during anesthesia induction. Acta Anaesthesiol Scand. 2010 May;54(5):596-602. doi: 10.1111/j.1399-6576.2010.02225.x. Epub 2010 Mar 10. |