This study investigated the effect of Trendelenburg position on preventing post-induction hypotension in elderly patients undergoing abdominal surgery with general anesthesia. The patients will receive the 10° Trendelenburg position or supine position during anesthesia induction. The primary outcome is the area under a mean arterial pressure (MAP) below 65 mm Hg within the first 15 minutes during anesthesia induction.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
PREVENTION
Masking
DOUBLE
Enrollment
168
After the loss of consciousness during general anesthesia, the 10° Trendelenburg position is adopted.
After the loss of consciousness during general anesthesia, the Supine Horizontal Position is adopted.
Zhejiang cancer hospital
Hangzhou, Zhejiang, China
The area under the curve of the mean arterial pressure being lower than 65 mmHg
Time frame: within 15 minutes after anesthesia induction
The area under the curve of the mean arterial pressure being lower than 60 mmHg
Time frame: within 15 minutes after anesthesia induction
The area under the curve of the mean arterial pressure being lower than 50 mmHg
Time frame: within 15 minutes after anesthesia induction
The area under the curve of the mean arterial pressure being lower than 40 mmHg
Time frame: within 15 minutes after anesthesia induction
The duration during which the Mean Arterial Pressure (MAP) is less than 65 mmHg
Time frame: within 15 minutes after anesthesia induction
The duration during which the Mean Arterial Pressure (MAP) is less than 60 mmHg
Time frame: within 15 minutes after anesthesia induction
The duration during which the Mean Arterial Pressure (MAP) is less than 50 mmHg
Time frame: within 15 minutes after anesthesia induction
The duration during which the Mean Arterial Pressure (MAP) is less than 40 mmHg
Time frame: within 15 minutes after anesthesia induction
The usage of vasoactive drugs
The vasoactive drugs are selected from the following according to the protocol: phenylephrine, ephedrine, norepinephrine, and epinephrine.
Time frame: within 15 minutes after anesthesia induction and during the whole process of the surgery
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The lowest mean arterial pressure
Time frame: within 15 minutes after anesthesia induction
the postoperative complications
The complications are assessed using the Claviene-Dindo score.
Time frame: within 30 days after surgery
the postoperative recovery
The postoperative recovery is assessed using the quality of recovery-15 questionnaire (QoR-15) .The QoR-15 has 15 questions. Each question is rated on a 10-point scale, ranging from 0 (none of the time or poor) to 10 (all of the time or excellent). The maximum score (best recovery) is 150.
Time frame: on postoperative day 1
Length of hospital stay after surgery
Time frame: through study completion, an average of 3-15 days
The time duration required to complete endotracheal intubation
Time frame: through study completion, an average of 10-60 s
The incidence of refractory hypotension
If either of the following two definitions is met, it is considered refractory hypotension: 1. During the anesthesia induction period, the total administered dosage exceeds the maximum dose, and the patient's hypotension does not recover. The maximum usage dose of ephedrine is 0.5 mg/kg (ideal body weight), and the maximum usage dose of phenylephrine is 8 μg/kg (ideal body weight). 2. When two or more vasoactive drugs are used, the systolic blood pressure is less than 80 mmHg or the mean blood pressure is less than 65 mmHg continuously for more than 5 minutes.
Time frame: within 15 minutes after anesthesia induction
The number of attempts at tracheal intubation
Time frame: through study completion, an average of 1-2times
The dosage of propofol during the anesthesia induction period
Time frame: within 15 minutes after anesthesia induction
The dosage of remifentanil during the anesthesia induction period
Time frame: within 15 minutes after anesthesia induction
The VIDIAC score of the video laryngoscope.
The VIDIAC score is comprised of: E, the interaction between the blade tip and epiglottis; V, the best view of the vocal cords from the blade camera; and A, enlargement of the arytenoids. The score range of the VIDIAC score is from -1 to 5 points. The VIDIAC score classification is as follows: Easy, with a score of -1 or 0; Moderate, with a score of 1; Difficult, with a score of 2; Severe, with a score of ≥3.
Time frame: through study completion, an average of -1~1 points
The usage of other medications during the anesthesia induction period
The usage of medications other than propofol, remifentanil, phenylephrine, ephedrine, norepinephrine, and epinephrine.
Time frame: within 15 minutes after anesthesia induction
The area under the curve of the mean arterial pressure being lower than 65 mmHg
Time frame: within 20 minutes after anesthesia induction
The pulse pressure variation rate after mechanical ventilation.
Time frame: At the 1st, 3rd, 5th and 10th minutes after tracheal intubation
The peak airway pressure after mechanical ventilation.
Time frame: At the 1st minutes after tracheal intubation
The infusion volume of crystalloid solution during the induction period.
Time frame: within 15 minutes after anesthesia induction
Arterial systolic pressure after anesthesia induction
The monitor records continuous arterial blood pressure data at intervals of 1 second.
Time frame: At the 1st, 2nd, 3rd, 4th, 5th, 6th, 7th, 8th, 9th, 10th, 11th, 12th, 13th, 14th, 15th, 16th, 17th, 18th, 19th and 20th minutes after anesthesia induction.
Arterial diastolic pressure after anesthesia induction
The monitor records continuous arterial blood pressure data at intervals of 1 second.
Time frame: At the 1st, 2nd, 3rd, 4th, 5th, 6th, 7th, 8th, 9th, 10th, 11th, 12th, 13th, 14th, 15th, 16th, 17th, 18th, 19th and 20th minutes after anesthesia induction.
Mean arterial pressure after anesthesia induction
The monitor records continuous arterial blood pressure data at intervals of 1 second.
Time frame: At the 1st, 2nd, 3rd, 4th, 5th, 6th, 7th, 8th, 9th, 10th, 11th, 12th, 13th, 14th, 15th, 16th, 17th, 18th, 19th and 20th minutes after anesthesia induction.
Heart rate after anesthesia induction
Time frame: At the 1st, 2nd, 3rd, 4th, 5th, 6th, 7th, 8th, 9th, 10th, 11th, 12th, 13th, 14th, 15th, 16th, 17th, 18th, 19th and 20th minutes after anesthesia induction.