Hypotension is common during surgery and about one-third of hypotension occur during the period from anesthesia induction to skin incision. Therefore, monitoring blood pressure during this period is crucial. Two methods are used for measuring blood pressure during surgery: the intermittent measurement method (oscillometric method) and the continuous measurement method (arterial catheterization method). The latter is frequently used in surgical patients who require meticulous hemodynamic management, although there is no clearly defined indication for its use. Despite the benefits of arterial catheterization, it is often delayed after induction of general anesthesia, and blood pressure is monitored intermittently using the oscillometric method. A recent study showed that continuous arterial pressure monitoring using arterial catheterization method during the induction of general anesthesia reduced hypotension significantly compared to 2.5-min interval intermittent arterial pressure monitoring using oscillometric method. The study was conducted on patients scheduled for continuous arterial pressure monitoring during surgery and the group with continuous arterial pressure monitoring showed significantly lower incidence of hypotension during the first 15 minutes of anesthesia induction. However, measuring blood pressure using the oscillometric method at 1-min interval, rather than 2.5-min interval, may not be significantly inferior to continuous monitoring via arterial catheterization in terms of hypotension occurrence. This study aims to compare hypotension incidence between arterial catheterization method and oscillometric method with 1-min interval during induction of anesthesia in non-cardiac surgery patients.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
PREVENTION
Masking
TRIPLE
Enrollment
258
Before induction of anesthesia, 20-gauge catheter is inserted to radial artery after local anesthesia with lidocaine, and continuous blood pressure monitoring is started. Anesthesia is induced using propofol, opioids (fentanyl or remifentanil), and neuromuscular relaxants (rocuronium, cisatracurium, or vecuronium). For maintenance of anesthesia, propofol infusion or inhalation anesthetics (sevoflurane or desflurane) are used. From the start of anesthesia induction to 15 minutes after, arterial blood pressure is monitored at 1-min interval using oscillometric method. The display of continuous arterial pressure on the anesthesia monitor is turned off during the 15-min study period.
During the same time window for 1-min interval oscillometric method, arterial blood pressure is monitored using continuous blood pressure monitoring.
Seoul National University Hospital
Seoul, Seoul, South Korea
Korea University Guro Hospital
Seoul, South Korea
MAP integral
The area under the mean arterial pressure (MAP) of 65 mmHg calculated using the MAP recorded every second
Time frame: From the start of anesthesia induction to 15 minutes after
Area under MAP of 60, 50, 40 mmHg (mmHg∙min)
calculated using the MAP recorded every second
Time frame: From the start of anesthesia induction to 15 minutes after
Duration of MAP <65, <60, <50, <40 mmHg (min)
calculated using the MAP recorded every second
Time frame: From the start of anesthesia induction to 15 minutes after
Exposure to MAP <65, <60, <50, and <40 mmHg (binary)
calculated using the MAP recorded every second
Time frame: From the start of anesthesia induction to 15 minutes after
Exposure to continuous MAP <65, <60, <50, <40 mmHg for 1 minute or longer (binary)
calculated using the MAP recorded every second
Time frame: From the start of anesthesia induction to 15 minutes after
Area above MBP of 100, 110, 120, 140 mmHg (mmHg∙min)
calculated using the MAP recorded every second
Time frame: From the start of anesthesia induction to 15 minutes after
MAP standard deviation (mmHg)
calculated using the MAP recorded every second
Time frame: From the start of anesthesia induction to 15 minutes after
Use of vasopressor (binary)
ephedrine, phenylephrine, norepinephrine (binary)
Time frame: From the start of anesthesia induction to 15 minutes after
Use of vasopressor (dose)
ephedrine (mg), phenylephrine (μg/kg), norepinephrine (μg/kg)
Time frame: From the start of anesthesia induction to 15 minutes after
Crystalloid (ml)
Total amount of crystalloid administered
Time frame: From the start of anesthesia induction to 15 minutes after
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