Vascular Stiffness Clinical Trial
Official title:
The Relationship Between Volemic Status as Assessed by Bioimpedance Spectroscopy, Arterial Stiffness and Hemodynamic Instability During Induction of General Anesthesia
Arterial hypotension during induction of general anesthesia is a risk factor for developing
postoperative cardiovascular complications. After induction of general anesthesia patients
have a high risk of developing arterial hypotension due to anesthetic drugs who can depress
cardiac contractility and determine vasodilatation. Previous studies have shown that even
short periods of hypotension with a mean arterial pressure of less than 55 mmHg during
surgery is associated with an increased incidence of cardiac injury and acute kidney injury
in the postoperative period.
The volemic status of the patients in the preoperative period is very difficult to quantify
and can vary due to comorbidities of the patient, chronic treatment, preoperative fasting.
Bioimpedance is recognized by over 30 years as a simple and non invasive technique to
determine the volemic status especially in the hemodialysed patients. A new device BCM- Body
Composition Monitoring (Fresenius Medical Care) offers a simple method to determine
extracellular water and total body water. These volumes are determined by measuring impedance
at 50 different frequencies thru electrodes placed at the ankle and wrist. BCM can also
determine lean tissue mass and adipose tissue mass.
Increasing arterial stiffness is the main characteristic of arterial aging; this increase
determines the increase of the afterload, left ventricular hypertrophy, the decrease of
coronary and tissue perfusion. Arterial applanation tonometry is a non-invasive technique
that has been shown to reliably provide indices of arterial stiffness.
In this study investigators wish to determine if there is a correlation between the hidric
status determined by BCM, carotid-femural pulse wave velocity determined with SphygmoCor
system and the development of hypotension during induction of general anesthesia. The
measurements will be obtained before induction of general anesthesia in the pre-surgical
area. During induction of general anesthesia with standard induction agents and Bispectral
index monitoring, brachial blood pressure will be measured by a cuff every minute after the
loss of verbal contact with the patient up to ten minutes after tracheal intubation. A
hypotensive response to anesthesia will be defined as a drop in mean arterial pressure below
55mmHg or a drop in mean arterial pressure with more than 40% than the base line value of the
patient before the surgery.
Measurement of the hidric status and aortic stiffness may represent a valid indicator of the
risk of hypotension during anesthesia induction.
Arterial hypotension during induction of general anesthesia is a risk factor for developing
postoperative cardiovascular complications. After induction of general anesthesia patients
have a high risk of developing arterial hypotension due to anesthetic drugs who can depress
cardiac contractility and determine vasodilatation. Risk factors associated with increased
incidence of arterial hypotension at induction of general anesthesia are age > 50 years, ASA
risk class III or IV, using high doses of propofol or fetanyl at induction. Previous studies
have shown that even short periods of hypotension with a mean arterial pressure of less than
55 mmHg during surgery is associated with an increased incidence of cardiac injury and acute
kidney injury in the postoperative period. Even if it is known that arterial hypotension is
associated with increased incidence of postoperative complications, the inferior limit and
duration of hypotension is not well defined. The volemic status of the patients in the
preoperative period is very difficult to quantify and can vary due to comorbidities of the
patient, chronic treatment, preoperative fasting. Bioimpedance is recognized by over 30 years
as a simple and non invasive technique to determine the volemic status especially in the
hemodialyzed patients. A new device BCM- Body Composition Monitoring (Fresenius Medical Care)
offers a simple method to determine extracellular water and total body water. These volumes
are determined by measuring impedance at 50 different frequencies thrue electrodes placed at
the ankle and wrist. BCM can also determine lean tissue mass and adipose tissue mass.
Increasing arterial stiffness is the main characteristic of arterial aging; this increase
determines the increase of the afterload, left ventricular hypertrophy, the decrease of
coronary and tissue perfusion. Increased arterial stiffness is associated with altered
ability of maintaining a normal arterial pressure during stress conditions; it is known the
risk of orthostatic hypotension in older patients wits increased arterial stiffness Arterial
applanation tonometry is asimple, non-invasive technique that has been shown to reliably
provide indices of arterial stiffness. Measuring carotid-femural pulse wave velocity thrue
applanation tonometry is considered the "gold standard" for measuring arterial stiffness.In
this study carotid-femoral pulse wave velocity will be determined by applanation tonometry
using the Sphygmocor system by sequentially recording ECG-gated carotid and femoral artery
waveforms. Pulse wave signals will be recorded by tonometers positioned at the base of the
right common carotid artery and over the right femoral artery.
In this study investigators wish to determine if there is a correlation between the hidric
status determined by BCM, carotid-femural pulse wave velocity determined with SphygmoCor
system and the development of hypotension during induction of general anesthesia. The
measurements will be obtained before induction of general anesthesia in the pre-surgical
area. During induction of general anesthesia with standard induction agents(fentanyl
propofol, rocuronium) and Bispectral index monitoring, brachial blood pressure will be
measured by a cuff every minute after the loss of verbal contact with the patient up to ten
minutes after tracheal intubation. A hypotensive response to anesthesia will be defined as a
drop in mean arterial pressure below 55mmHg or a drop in mean arterial pressure with more
than 40% than the base line value of the patient before the surgery.
Study population : patients who are going under surgery. Inclusion criteria: there will be
two study populations. The first study population will represent patients scheduled for
surgery for a new diagnosed cancer pathology. The second study population will represent
patients scheduled for surgery not for cancer disease. Exclusion criteria: diabetes (on
insulin therapy), renal insufficiency (creatinine>2.0mg/dl), history of arterial bypass),
history of carotid endoarterectomy, atrial fibrillation/flutter, history of ischemic stroke,
transient ischemic attack, myocardial infarction or coronary revascularization (any type)
within 6 months, known left main or 3-vessel coronary disease positive myocardial perfusion
study without subsequent revascularization, heart failure (>3 NYHA) class 3, known left
ventricle ejection fraction <30%, pulmonary hypertension (PA systolic >50mmHg), right
ventricle dysfunction, sepsis, pregnancy, limb amputation.
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