Minimisation of Blood Pressure Variability and Postoperative Nausea and Vomiting

Blood Pressure Clinical Trial

— SICK  

Official title:

The Effect of Minimizing Blood Pressure Variability on Postoperative Nausea and Vomiting in Women Undergoing Non-cardiac Surgery With Minor to Moderate Risk - a Prospective Randomized Clinical Trial

Clinical Trial Details — Status: Recruiting

Administrative data

• NCT number: NCT05596695
• Other study ID #: SICK_01
• Status: Recruiting
• Phase: N/A
• Start date: October 1, 2022
• Est. completion date: February 1, 2026

Study information

• Verified date: July 2023
• Source: Medical University of Vienna
• Contact: Katharina Horvath, MD
• Phone: 0043 1 40400
• Email: katharina.horvath[@]meduniwien.ac.at
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

Intraoperative hypotension is associated with postoperative nausea and vomiting (PONV). Even though the exact mechanism linking PONV and hypotension is still unclear, a reduced intestinal tissue perfusion might trigger nausea and vomiting. Still to date only limited data evaluating intraoperative blood pressure and the incidence of PONV after general anesthesia exits. Furthermore, the effect of intraoperative blood pressure variability on the incidence of PONV has not been investigated yet. Therefore, we will test our primary hypothesis that the incidence of PONV during the early (0-2h) postoperative period will be minimized by targeting intraoperative blood pressure variability to a SPB of 120±5mmHg by using a continuous vasopressor infusion in female patients undergoing elective minor to moderate risk non-cardiac surgery.

Description:

Background: Intraoperative hypotension is associated with postoperative nausea and vomiting (PONV). Even though the exact mechanism linking PONV and hypotension is still unclear, a reduced intestinal tissue perfusion might trigger nausea and vomiting. Still to date only limited data evaluating intraoperative blood pressure and the incidence of PONV after general anesthesia exits. Furthermore, the effect of intraoperative blood pressure variability on the incidence of PONV has not been investigated yet. Therefore, we will test our primary hypothesis that the incidence of PONV during the early (0-2h) postoperative period will be minimized by targeting intraoperative blood pressure variability to a SPB of 120±5mmHg by using a continuous vasopressor infusion in female patients undergoing elective minor to moderate risk non-cardiac surgery.

Methods: We will include 272 women between 18 and 50 years of age undergoing minor- to moderate-risk noncardiac surgery in this randomized, double-blinded clinical trial. Patients will randomly be assigned to intraoperative management of blood pressure with a SPB of 120±5mmHg (intervention group) or standard of care intraoperative blood pressure management (control group). Our primary outcome will be the incidence of PONV during the early (0-2h) postoperative period between the groups. Nausea will be assessed in 15-min intervals in the PACU for the first two postoperative hours on a 100mm visual analog scale. A PONV episode will be defined as the occurrence of nausea (VAS 50mm or greater) or vomiting.

Statistics: The primary outcome, the incidence of PONV during the early (0-2 hours) postoperative period will be compared between the intervention and control group using a Chi- Square-Test.

Level of originality: Data regarding the effects of intraoperative blood pressure on PONV are very limited and mainly available from retrospective analysis. So far, the effects of blood pressure variability on PONV have not been investigated yet. As PONV is still one of the most common complications after general anaesthesia leading to delayed discharge from PACU, patient discomfort and increased medical costs, it is important to search for additional methods to manage PONV. Our patient population, being at increased risk of PONV, could therefore profit from a more rapid postoperative recovery.

Recruitment information / eligibility

• Status: Recruiting
• Enrollment: 272
• Est. completion date: February 1, 2026
• Est. primary completion date: October 1, 2025
• Accepts healthy volunteers: No
• Gender: Female
• Age group: 18 Years to 50 Years

Eligibility

Inclusion Criteria:

• Women 18-50 years of age at time of surgery

• ASA physical status I and II

• Scheduled for elective minor or moderate risk non-cardiac surgery with expected time of surgery =1 hour

Exclusion Criteria:

• Patients undergoing emergency surgery

• Scheduled for pheochromocytoma surgery

• Nausea and/or vomiting on the morning before surgery

• Taking anti-emetic drugs

• Pregnancy

• Dysfunction of the vestibular system

Related Conditions & MeSH terms

• Blood Pressure
• PONV
• Postoperative Nausea and Vomiting
• Postoperative Recovery
• Vomiting

Intervention

Other:
• Minimizing blood pressure variability
Intraoperative blood pressure management will be performed to maintain a systolic blood pressure of 120 ±5mmHg using a continuous infusion of a vasopressor starting at induction of anaesthesia.

Locations

Country	Name	City	State
Austria	Medical University of Vienna	Vienna

Sponsors (1)

Lead Sponsor	Collaborator
Medical University of Vienna

Country where clinical trial is conducted

Austria, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Other	Exploratory Outcome 1: Intraoperative cerebral oxygen saturation between study groups	Intraoperative non-invasive near-infrared spectroscopy for measurement of cerebral oxygenation.	Throughout surgery
Other	Exploratory Outcome 2: Intraoperative cerebral oxygen saturation between patients, who experienced PONV, and patients without PONV	Intraoperative non-invasive near-infrared spectroscopy for measurement of cerebral oxygenation.	Throughout surgery and first two postoperative hours
Other	Exploratory Outcome 3: Impact of Event Scale-Revised	A self-report measure to evaluate the presence of posttraumatic stress disorder. It consists of 22 items, which are rated on a 4-point scale ranging from 0 ("not at all") to 4 ("extremely"). Values are added up for the avoidance subscale, the intrusion subscale and the hyperarousal subcale and X is calculated via the following formula: X = (-0,02 x Intrusion) + (0,07 x Avoidance) + (0,15 x Hyperarousal) - 4,36. A value for X > 0 indicates the likely presence of PTSD.	Before surgery
Other	Substudy 1: Preoperative Copeptin	Comparison between preoperative Copeptin concentrations between patients with and without PONV.	Before surgery
Primary	PONV	Incidence of postoperative nausea and vomiting within the first two postoperative hours.	First two postoperative hours
Secondary	Secondary Outcome 1: Late PONV	Incidence of postoperative nausea and vomiting within the first three postoperative days	First three postoperative days
Secondary	Secondary Outcome 2: Modified Aldrete Score	A score to assess readiness of discharge from postanesthesia care unit (PACU). Patients can achieve 0-14 points in the modified Aldrete Score. A modified Aldrete Score > 12 points signals that criteria for discharge from PACU have been fulfilled, a modified Aldrete Score < 12 points signals that patients should stay in PACU.	First two postoperative hours
Secondary	Secondary Outcome 3: Ready for Hospital Discharge Scale	A score to evaluate patients' subjective readiness for hospital discharge. Patients can achieve 0-80 points in the Ready for Hospital Discharge Scale. Higher scores mean that patients are ready for hospital discharge, lower scores mean that patients are not ready for hospital discharge.	First three postoperative days