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The goal of this observational study is to compare post-induction hypotension treatments with PRAM method in Gynecologic Oncological Cases. The goal of this observational study is to compare post-induction hypotension treatments with PRAM method in Gynecologic Oncological Cases.
Post-induction hypotension is defined as hypotension that occurs within the first 20-30 minutes after general anesthesia induction or during the period between anesthesia induction and surgical incision. The global incidence rates are reported to be approximately 10.3%, with some studies indicating rates as high as 66.96%. Post-induction hypotension is associated with increased postoperative morbidity risks, such as acute kidney injury, transient tubular dysfunction, myocardial injury, and the need for postoperative intensive care. However, hypotension is a modifiable and preventable risk factor; its early detection and appropriate treatment can improve patient outcomes.
For this reason, investigators aimed to investigate the repeated dose requirements of alpha-adrenergic drugs, the recurrence of hypotension, and their effects on parameters observed via the MostCare monitor in patients undergoing major gynecologic oncologic surgeries during standard anesthesia induction and maintenance. This investigation focuses on patients experiencing a mean arterial pressure <65 mmHg or a >30% reduction in baseline systolic blood pressure within the first 30 minutes after induction or until surgical incision. Additionally, our secondary aim is to examine other parameters that may be associated with post-induction hypotension.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Ephedrine | When post-induction hypotension occurred patients were treated with 5 milligrams ephedrine in this group. If blood pressure does not reach desired levels, same dosage will be repeated 5 minutes later from administration. Maximum 3 doses will be applied and if hypotension ist persist the treatment will changed to rescue treatment. |
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| Noradrenaline | When post-induction hypotension occurred patients were treated with 5 micrograms noradrenaline in this group. If blood pressure does not reach desired levels, same dosage will be repeated 5 minutes later from administration. Maximum 3 doses will be applied and if hypotension ist persist the treatment will changed to rescue treatment. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Ephedrine | Drug | 5 milligrams of ephedrine will be applied when post-induction hypotension occured. After 3 doses, dose will be increased or changed to other treatment options. |
|
| Measure | Description | Time Frame |
|---|---|---|
| "Is there a difference in the need for repeated doses of treatments to reach the target blood pressure in patients who develop post-induction hypotension?" | When hypotension is occured, researchers applied two treatment (e.g. Ephedrine and Norepinephrine) and assessed how many hypotension episodes occured after treatment | First 30 minutes after anesthesia induction or time to skin incision |
| "Is there a difference in the time to reach the target blood pressure after treatments in patients who develop post-induction hypotension?" | When hypotension is occured, researchers applied two treatment (e.g. Ephedrine and Norepinephrine) and assessed that is there a difference in the time to reach the target blood pressure after treatments | First 30 minutes after anesthesia induction or time to skin incision |
| Measure | Description | Time Frame |
|---|---|---|
| Systemic vascular resistance (SVR) | To examine the effects of the applied treatments on the systemic vascular resistance from the PRAM method and compare them with each other. | First 30 minutes after anesthesia induction or time to skin incision |
| Arterial Elastance (Ea) |
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Inclusion Criteria:
Exclusion Criteria:
Since our study is conducted on gynecologic oncology patients, all of our patients are women.
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The investigators choose Gynecological Oncology patients who will operated for gyno-oncological reasons
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| Name | Affiliation | Role |
|---|---|---|
| Akgün E Şarer, Ass. Prof. | Ankara City Hospital Bilkent | Study Director |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Ankara Bilkent Şehir Hastanesi | Ankara | 06660 | Turkey (Türkiye) |
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| ID | Term |
|---|---|
| D004809 | Ephedrine |
| ID | Term |
|---|---|
| D011412 | Propanolamines |
| D000605 | Amino Alcohols |
| D000438 | Alcohols |
| D009930 | Organic Chemicals |
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| Noradrenalin | Drug | 5 micrograms of ephedrine will be applied when post-induction hypotension occured. After 3 doses, dose will be increased or changed to other treatment options. |
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To examine the effects of the applied treatments on the Ea from the PRAM method and compare them with each other. |
| First 30 minutes after anesthesia induction or time to skin incision |
| Cardiac Output (CO) | To examine the effects of the applied treatments on the CO from the PRAM method and compare them with each other. | First 30 minutes after anesthesia induction or time to skin incision |
| Stroke Volume (SV) | To examine the effects of the applied treatments on the SV from the PRAM method and compare them with each other. | First 30 minutes after anesthesia induction or time to skin incision |
| Cardiac Cycle Efficiency (CCE) | To examine the effects of the applied treatments on the CCE from the PRAM method and compare them with each other. | First 30 minutes after anesthesia induction or time to skin incision |
| D020005 |
| Propanols |
| D000588 | Amines |
| D010627 | Phenethylamines |
| D005021 | Ethylamines |