Comparison of Leg Elevation & Leg Wrapping in the NCT02845921

Clinical Trial Details — Status: Recruiting

Administrative data
NCT number	NCT02845921
Other study ID #	INST.EC/EC/066/2015-16
Secondary ID
Status	Recruiting
Phase	N/A
First received	June 30, 2016
Last updated	July 23, 2016
Start date	January 2016
Est. completion date	December 2017

Study information
Verified date	July 2016
Source	Nitte University
Contact	Sara Jaison, MBBS
Phone	09846863119
Email	sara_jaison[@]yahoo.co.in
Is FDA regulated	No
Health authority	India: Indian Council of Medical Research
Study type	Interventional

Clinical Trial Summary

Propofol is an intravenous anaesthetic agent used for both induction and maintenance of anaesthesia. An important adverse effect is the significant fall in blood pressure. The current clinical study will be done to determine the efficacy of leg elevation and wrapping in reducing the incidence and severity of propofol induced hypotension in patients undergoing general anaesthesia.

Description:

Propofol is an intravenous anaesthetic agent used for both induction and maintenance of anaesthesia. It is widely employed due to its quick onset of action, short half life and rapid recovery. An important adverse effect is the significant fall in blood pressure. Although the exact mechanism of propofol induced hypotension is not known, venodilation, decreased peripheral resistance and decrease in cardiac output has been suggested.2 Though the hypotension is transient, it can produce devastating effects. Hence there is a need to prevent it. Moreover, several attempts at treating propofol induced hypotension have been met with variable and limited success.

Hypotension following spinal anaesthesia is also a frequent problem. It is generally treated with intravenous fluids and vasopressors. Simple and non pharmacological measures like leg elevation and leg wrapping with Esmarch bandage were reported to be successful.3 These reduce the incidence and severity of hypotension associated with spinal anaesthesia by improving the venous return.

The mechanisms of hypotension following intravenous propofol and spinal anaesthesia are almost similar. Therefore, the investigators hypothesize that leg elevation and wrapping can be attempted to reduce propofol induced hypotension. They are simple and cost effective techniques that will reduce the need for pharmacological measures to control hypotension. As the literature search did not reveal any information regarding the usefulness of these techniques in propofol induced hypotension, the current clinical study will be done to determine the efficacy of leg elevation and wrapping in reducing the incidence and severity of propofol induced hypotension in patients undergoing general anaesthesia.

The current study will compare the efficacy of leg elevation and leg wrapping in reducing the incidence and severity of propofol induced hypotension in terms of incidence of hypotension, magnitude of decrease in systolic, diastolic and mean arterial blood pressures, need for pharmacological measures to treat hypotension, changes in heart rate and adverse clinical outcomes, if any. It will be a prospective randomised controlled open label study from January 2016 to August 2017 involving 150 adult patients undergoing general anaesthesia.

For statistical analysis, descriptive statistics - minimum, maximum, mean and standard deviation will be used. Independent sample t test for data following normal distribution and for data not following normal distribution, Mann-Whitney U test will be used. P value less than 0.05 will be considered statistically significant. To study relationship between hypotension and other variables, Pearson's correlation will be used. Confidence interval will be calculated to 95%.

Recruitment information / eligibility
Status	Recruiting
Enrollment	150
Est. completion date	December 2017
Est. primary completion date	August 2017
Accepts healthy volunteers	No
Gender	Both
Age group	18 Years to 60 Years
Eligibility	Inclusion Criteria: - Patients belonging to ASA physical status I and II undergoing endotracheal general anaesthesia Exclusion Criteria: - Patient refusal - Contraindication to application of bandage - Partial or complete limb amputation - Difficult airway - Use of extraglottic airway device - Pregnancy - On antihypertensive or vasoactive medication - Autonomic neuropathy

Study Design

Allocation: Randomized, Endpoint Classification: Pharmacodynamics Study, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Prevention

Related Conditions & MeSH terms

Intervention

Other:
• leg elevation
A stand making an angle of 30 degree to the horizontal is used to elevate both the legs
• leg wrapping
Esmarch bandage is used to wrap each lower limb
• control
no intervention has been done

Locations
Country	Name	City	State
India	Justice K. S. Hegde Hospital, K S Hegde Medical Academy, Nitte University	Mangalore	Dakshina Kannada

Sponsors *(1)*
Lead Sponsor	Collaborator
Nitte University

Country where clinical trial is conducted

India,

References & Publications (7)

Masoudifar M, Beheshtian E. Comparison of cardiovascular response to laryngoscopy and tracheal intubation after induction of anesthesia by Propofol and Etomidate. J Res Med Sci. 2013 Oct;18(10):870-4. — View Citation

McNeir DA, Mainous EG, Trieger N. Propofol as an intravenous agent in general anesthesia and conscious sedation. Anesth Prog. 1988 Jul-Aug;35(4):147-51. Review. — View Citation

Möller Petrun A, Kamenik M. Bispectral index-guided induction of general anaesthesia in patients undergoing major abdominal surgery using propofol or etomidate: a double-blind, randomized, clinical trial. Br J Anaesth. 2013 Mar;110(3):388-96. doi: 10.1093/bja/aes416. Epub 2012 Nov 19. — View Citation

Muzi M, Berens RA, Kampine JP, Ebert TJ. Venodilation contributes to propofol-mediated hypotension in humans. Anesth Analg. 1992 Jun;74(6):877-83. — View Citation

Reich DL, Hossain S, Krol M, Baez B, Patel P, Bernstein A, Bodian CA. Predictors of hypotension after induction of general anesthesia. Anesth Analg. 2005 Sep;101(3):622-8, table of contents. — View Citation

Rout CC, Rocke DA, Gouws E. Leg elevation and wrapping in the prevention of hypotension following spinal anaesthesia for elective caesarean section. Anaesthesia. 1993 Apr;48(4):304-8. — View Citation

Singh K, Payal YS, Sharma JP, Nautiyal R. Evaluation of hemodynamic changes after leg wrapping in elective cesarean section under spinal anesthesia. J Obstet Anaesth Crit Care. 2014;4:23-8

Comparison of Leg Elevation and Leg Wrapping in the Prevention of Propofol Induced Hypotension

Clinical Trial Details — Status: Recruiting

Administrative data

Study information

Clinical Trial Summary

Description:

Recruitment information / eligibility

Study Design

Related Conditions & MeSH terms

Intervention

Locations

Sponsors (1)

Country where clinical trial is conducted

References & Publications (7)

Outcome

Outcome
Type	Measure	Description	Time frame	Safety issue
Other	Need for pharmacological measures to treat hypotension	Patient will be shifted to operation theatre. Non-invasive blood pressure (NIBP) monitor will be attached. Baseline mean arterial blood pressure (MAP) will be noted. Analgesia will be given by inj fentanyl. Lower limbs will be elevated, wrapped or none according to group allocation. MAP will be recorded again. 3 minutes of pre-oxygenation will be done. Anaesthesia will be induced with inj. propofol. MAP will be noted at induction with propofol and for every minute till 5 minutes after induction. Muscle relaxation by inj. vecuronium. Patient will be ventilated with oxygen for 5 minutes. Orotracheal intubation will be performed. MAP<55mm Hg will be treated by rapid intravenous fluid administration and by intravenous mephentermine 6mg bolus increments every minute until the systolic pressure rises to greater than 70% of baseline or to above 90mm Hg. Total dose of mephentermine required will be noted.	baseline, after leg elevation or wrapping, at induction with propofol, every minute till 5 minutes after induction, at intubation and every minute thereafter upto 10 min post intubation	No
Other	Tachycardia	Tachycardia will be defined as heart rate more than 100bpm or increase by more than 30% over baseline value. Any incidence of tachycardia during the procedure will be noted	baseline, after leg elevation or wrapping, at induction with propofol, every minute till 5 minutes after induction, at intubation and every minute thereafter upto 10 min post intubation	No
Other	Bradycardia	Bradycardia will be defined as heart rate less than 50bpm or decrease by more than 30% below baseline value. Any incidence of bradycardia during the procedure will be noted	baseline, after leg elevation or wrapping, at induction with propofol, every minute till 5 minutes after induction, at intubation and every minute thereafter upto 10 min post intubation	No
Other	Arrhythmia	any incidence of arrhythmia during the procedure will be noted	baseline, after leg elevation or wrapping, at induction with propofol, every minute till 5 minutes after induction, at intubation and every minute thereafter upto 10 min post intubation	No
Primary	incidence of hypotension at baseline	Patient will be shifted to operation theatre. Non-invasive blood pressure (NIBP) monitor will be attached. Baseline blood pressure including systolic, diastolic and mean arterial blood pressures will be noted. Analgesia will be given by inj fentanyl. Lower limbs will be elevated, wrapped or none according to group allocation. Blood pressures will be recorded again. 3 minutes of pre-oxygenation will be done. Anaesthesia will be induced with inj. propofol 2mg/kg body weight injected over 30 seconds. Blood pressures will be noted at induction with propofol and for every minute till 5 minutes after induction. Muscle relaxation will be achieved by inj. vecuronium. Patient will be ventilated with oxygen for 5 minutes. Orotracheal intubation will be performed with appropriate sized endotracheal tube. Hypotension will be defined as a drop in systolic blood pressure to less than 30% of baseline values or to MAP <60mm Hg. Incidence of hypotension will be noted.	baseline	No
Primary	incidence of hypotension at 0 minutes after leg elevation or wrapping	Patient will be shifted to operation theatre. Non-invasive blood pressure (NIBP) monitor will be attached. Baseline blood pressure including systolic, diastolic and mean arterial blood pressures will be noted. Analgesia will be given by inj fentanyl. Lower limbs will be elevated, wrapped or none according to group allocation. Blood pressures will be recorded again. 3 minutes of pre-oxygenation will be done. Anaesthesia will be induced with inj. propofol 2mg/kg body weight injected over 30 seconds. Blood pressures will be noted at induction with propofol and for every minute till 5 minutes after induction. Muscle relaxation will be achieved by inj. vecuronium. Patient will be ventilated with oxygen for 5 minutes. Orotracheal intubation will be performed with appropriate sized endotracheal tube. Hypotension will be defined as a drop in systolic blood pressure to less than 30% of baseline values or to MAP <60mm Hg. Incidence of hypotension will be noted.	0 minutes after leg elevation or wrapping	No
Primary	incidence of hypotension at 0 minutes after induction with propofol	Patient will be shifted to operation theatre. Non-invasive blood pressure (NIBP) monitor will be attached. Baseline blood pressure including systolic, diastolic and mean arterial blood pressures will be noted. Analgesia will be given by inj fentanyl. Lower limbs will be elevated, wrapped or none according to group allocation. Blood pressures will be recorded again. 3 minutes of pre-oxygenation will be done. Anaesthesia will be induced with inj. propofol 2mg/kg body weight injected over 30 seconds. Blood pressures will be noted at induction with propofol and for every minute till 5 minutes after induction. Muscle relaxation will be achieved by inj. vecuronium. Patient will be ventilated with oxygen for 5 minutes. Orotracheal intubation will be performed with appropriate sized endotracheal tube. Hypotension will be defined as a drop in systolic blood pressure to less than 30% of baseline values or to MAP <60mm Hg. Incidence of hypotension will be noted.	0 minutes after induction with propofol	No
Primary	incidence of hypotension at 1 minute after induction	Patient will be shifted to operation theatre. Non-invasive blood pressure (NIBP) monitor will be attached. Baseline blood pressure including systolic, diastolic and mean arterial blood pressures will be noted. Analgesia will be given by inj fentanyl. Lower limbs will be elevated, wrapped or none according to group allocation. Blood pressures will be recorded again. 3 minutes of pre-oxygenation will be done. Anaesthesia will be induced with inj. propofol 2mg/kg body weight injected over 30 seconds. Blood pressures will be noted at induction with propofol and for every minute till 5 minutes after induction. Muscle relaxation will be achieved by inj. vecuronium. Patient will be ventilated with oxygen for 5 minutes. Orotracheal intubation will be performed with appropriate sized endotracheal tube. Hypotension will be defined as a drop in systolic blood pressure to less than 30% of baseline values or to MAP <60mm Hg. Incidence of hypotension will be noted.	1 minute after induction	No
Primary	incidence of hypotension at 2 minutes after induction	Patient will be shifted to operation theatre. Non-invasive blood pressure (NIBP) monitor will be attached. Baseline blood pressure including systolic, diastolic and mean arterial blood pressures will be noted. Analgesia will be given by inj fentanyl. Lower limbs will be elevated, wrapped or none according to group allocation. Blood pressures will be recorded again. 3 minutes of pre-oxygenation will be done. Anaesthesia will be induced with inj. propofol 2mg/kg body weight injected over 30 seconds. Blood pressures will be noted at induction with propofol and for every minute till 5 minutes after induction. Muscle relaxation will be achieved by inj. vecuronium. Patient will be ventilated with oxygen for 5 minutes. Orotracheal intubation will be performed with appropriate sized endotracheal tube. Hypotension will be defined as a drop in systolic blood pressure to less than 30% of baseline values or to MAP <60mm Hg. Incidence of hypotension will be noted.	2 minutes after induction	No
Primary	incidence of hypotension at 3 minutes after induction	Patient will be shifted to operation theatre. Non-invasive blood pressure (NIBP) monitor will be attached. Baseline blood pressure including systolic, diastolic and mean arterial blood pressures will be noted. Analgesia will be given by inj fentanyl. Lower limbs will be elevated, wrapped or none according to group allocation. Blood pressures will be recorded again. 3 minutes of pre-oxygenation will be done. Anaesthesia will be induced with inj. propofol 2mg/kg body weight injected over 30 seconds. Blood pressures will be noted at induction with propofol and for every minute till 5 minutes after induction. Muscle relaxation will be achieved by inj. vecuronium. Patient will be ventilated with oxygen for 5 minutes. Orotracheal intubation will be performed with appropriate sized endotracheal tube. Hypotension will be defined as a drop in systolic blood pressure to less than 30% of baseline values or to MAP <60mm Hg. Incidence of hypotension will be noted.	3 minutes after induction	No
Primary	incidence of hypotension at 4 minutes after induction	Patient will be shifted to operation theatre. Non-invasive blood pressure (NIBP) monitor will be attached. Baseline blood pressure including systolic, diastolic and mean arterial blood pressures will be noted. Analgesia will be given by inj fentanyl. Lower limbs will be elevated, wrapped or none according to group allocation. Blood pressures will be recorded again. 3 minutes of pre-oxygenation will be done. Anaesthesia will be induced with inj. propofol 2mg/kg body weight injected over 30 seconds. Blood pressures will be noted at induction with propofol and for every minute till 5 minutes after induction. Muscle relaxation will be achieved by inj. vecuronium. Patient will be ventilated with oxygen for 5 minutes. Orotracheal intubation will be performed with appropriate sized endotracheal tube. Hypotension will be defined as a drop in systolic blood pressure to less than 30% of baseline values or to MAP <60mm Hg. Incidence of hypotension will be noted.	4 minutes after induction	No
Primary	incidence of hypotension at 5 minutes after induction	Patient will be shifted to operation theatre. Non-invasive blood pressure (NIBP) monitor will be attached. Baseline blood pressure including systolic, diastolic and mean arterial blood pressures will be noted. Analgesia will be given by inj fentanyl. Lower limbs will be elevated, wrapped or none according to group allocation. Blood pressures will be recorded again. 3 minutes of pre-oxygenation will be done. Anaesthesia will be induced with inj. propofol 2mg/kg body weight injected over 30 seconds. Blood pressures will be noted at induction with propofol and for every minute till 5 minutes after induction. Muscle relaxation will be achieved by inj. vecuronium. Patient will be ventilated with oxygen for 5 minutes. Orotracheal intubation will be performed with appropriate sized endotracheal tube. Hypotension will be defined as a drop in systolic blood pressure to less than 30% of baseline values or to MAP <60mm Hg. Incidence of hypotension will be noted.	5 minutes after induction	No
Primary	incidence of hypotension at 0 minutes after intubation	Patient will be shifted to operation theatre. Non-invasive blood pressure (NIBP) monitor will be attached. Baseline blood pressure including systolic, diastolic and mean arterial blood pressures will be noted. Analgesia will be given by inj fentanyl. Lower limbs will be elevated, wrapped or none according to group allocation. Blood pressures will be recorded again. 3 minutes of pre-oxygenation will be done. Anaesthesia will be induced with inj. propofol 2mg/kg body weight injected over 30 seconds. Blood pressures will be noted at induction with propofol and for every minute till 5 minutes after induction. Muscle relaxation will be achieved by inj. vecuronium. Patient will be ventilated with oxygen for 5 minutes. Orotracheal intubation will be performed with appropriate sized endotracheal tube. Hypotension will be defined as a drop in systolic blood pressure to less than 30% of baseline values or to MAP <60mm Hg. Incidence of hypotension will be noted.	0 minutes after intubation	No
Primary	incidence of hypotension at 1 minute after intubation	Patient will be shifted to operation theatre. Non-invasive blood pressure (NIBP) monitor will be attached. Baseline blood pressure including systolic, diastolic and mean arterial blood pressures will be noted. Analgesia will be given by inj fentanyl. Lower limbs will be elevated, wrapped or none according to group allocation. Blood pressures will be recorded again. 3 minutes of pre-oxygenation will be done. Anaesthesia will be induced with inj. propofol 2mg/kg body weight injected over 30 seconds. Blood pressures will be noted at induction with propofol and for every minute till 5 minutes after induction. Muscle relaxation will be achieved by inj. vecuronium. Patient will be ventilated with oxygen for 5 minutes. Orotracheal intubation will be performed with appropriate sized endotracheal tube. Hypotension will be defined as a drop in systolic blood pressure to less than 30% of baseline values or to MAP <60mm Hg. Incidence of hypotension will be noted.	1 minute after intubation	No
Primary	incidence of hypotension at 2 minutes after intubation	Patient will be shifted to operation theatre. Non-invasive blood pressure (NIBP) monitor will be attached. Baseline blood pressure including systolic, diastolic and mean arterial blood pressures will be noted. Analgesia will be given by inj fentanyl. Lower limbs will be elevated, wrapped or none according to group allocation. Blood pressures will be recorded again. 3 minutes of pre-oxygenation will be done. Anaesthesia will be induced with inj. propofol 2mg/kg body weight injected over 30 seconds. Blood pressures will be noted at induction with propofol and for every minute till 5 minutes after induction. Muscle relaxation will be achieved by inj. vecuronium. Patient will be ventilated with oxygen for 5 minutes. Orotracheal intubation will be performed with appropriate sized endotracheal tube. Hypotension will be defined as a drop in systolic blood pressure to less than 30% of baseline values or to MAP <60mm Hg. Incidence of hypotension will be noted.	2 minutes after intubation	No
Primary	incidence of hypotension at 3 minutes after intubation	Patient will be shifted to operation theatre. Non-invasive blood pressure (NIBP) monitor will be attached. Baseline blood pressure including systolic, diastolic and mean arterial blood pressures will be noted. Analgesia will be given by inj fentanyl. Lower limbs will be elevated, wrapped or none according to group allocation. Blood pressures will be recorded again. 3 minutes of pre-oxygenation will be done. Anaesthesia will be induced with inj. propofol 2mg/kg body weight injected over 30 seconds. Blood pressures will be noted at induction with propofol and for every minute till 5 minutes after induction. Muscle relaxation will be achieved by inj. vecuronium. Patient will be ventilated with oxygen for 5 minutes. Orotracheal intubation will be performed with appropriate sized endotracheal tube. Hypotension will be defined as a drop in systolic blood pressure to less than 30% of baseline values or to MAP <60mm Hg. Incidence of hypotension will be noted.	3 minutes after intubation	No
Primary	incidence of hypotension at 4 minutes after intubation	Patient will be shifted to operation theatre. Non-invasive blood pressure (NIBP) monitor will be attached. Baseline blood pressure including systolic, diastolic and mean arterial blood pressures will be noted. Analgesia will be given by inj fentanyl. Lower limbs will be elevated, wrapped or none according to group allocation. Blood pressures will be recorded again. 3 minutes of pre-oxygenation will be done. Anaesthesia will be induced with inj. propofol 2mg/kg body weight injected over 30 seconds. Blood pressures will be noted at induction with propofol and for every minute till 5 minutes after induction. Muscle relaxation will be achieved by inj. vecuronium. Patient will be ventilated with oxygen for 5 minutes. Orotracheal intubation will be performed with appropriate sized endotracheal tube. Hypotension will be defined as a drop in systolic blood pressure to less than 30% of baseline values or to MAP <60mm Hg. Incidence of hypotension will be noted.	4 minutes after intubation	No
Primary	incidence of hypotension at 5 minutes after intubation	Patient will be shifted to operation theatre. Non-invasive blood pressure (NIBP) monitor will be attached. Baseline blood pressure including systolic, diastolic and mean arterial blood pressures will be noted. Analgesia will be given by inj fentanyl. Lower limbs will be elevated, wrapped or none according to group allocation. Blood pressures will be recorded again. 3 minutes of pre-oxygenation will be done. Anaesthesia will be induced with inj. propofol 2mg/kg body weight injected over 30 seconds. Blood pressures will be noted at induction with propofol and for every minute till 5 minutes after induction. Muscle relaxation will be achieved by inj. vecuronium. Patient will be ventilated with oxygen for 5 minutes. Orotracheal intubation will be performed with appropriate sized endotracheal tube. Hypotension will be defined as a drop in systolic blood pressure to less than 30% of baseline values or to MAP <60mm Hg. Incidence of hypotension will be noted.	5 minutes after intubation	No
Primary	incidence of hypotension at 6 minutes after intubation	Patient will be shifted to operation theatre. Non-invasive blood pressure (NIBP) monitor will be attached. Baseline blood pressure including systolic, diastolic and mean arterial blood pressures will be noted. Analgesia will be given by inj fentanyl. Lower limbs will be elevated, wrapped or none according to group allocation. Blood pressures will be recorded again. 3 minutes of pre-oxygenation will be done. Anaesthesia will be induced with inj. propofol 2mg/kg body weight injected over 30 seconds. Blood pressures will be noted at induction with propofol and for every minute till 5 minutes after induction. Muscle relaxation will be achieved by inj. vecuronium. Patient will be ventilated with oxygen for 5 minutes. Orotracheal intubation will be performed with appropriate sized endotracheal tube. Hypotension will be defined as a drop in systolic blood pressure to less than 30% of baseline values or to MAP <60mm Hg. Incidence of hypotension will be noted.	6 minutes after intubation	No
Primary	incidence of hypotension at 7 minutes after intubation	Patient will be shifted to operation theatre. Non-invasive blood pressure (NIBP) monitor will be attached. Baseline blood pressure including systolic, diastolic and mean arterial blood pressures will be noted. Analgesia will be given by inj fentanyl. Lower limbs will be elevated, wrapped or none according to group allocation. Blood pressures will be recorded again. 3 minutes of pre-oxygenation will be done. Anaesthesia will be induced with inj. propofol 2mg/kg body weight injected over 30 seconds. Blood pressures will be noted at induction with propofol and for every minute till 5 minutes after induction. Muscle relaxation will be achieved by inj. vecuronium. Patient will be ventilated with oxygen for 5 minutes. Orotracheal intubation will be performed with appropriate sized endotracheal tube. Hypotension will be defined as a drop in systolic blood pressure to less than 30% of baseline values or to MAP <60mm Hg. Incidence of hypotension will be noted.	7 minutes after intubation	No
Primary	incidence of hypotension at 8 minutes after intubation	Patient will be shifted to operation theatre. Non-invasive blood pressure (NIBP) monitor will be attached. Baseline blood pressure including systolic, diastolic and mean arterial blood pressures will be noted. Analgesia will be given by inj fentanyl. Lower limbs will be elevated, wrapped or none according to group allocation. Blood pressures will be recorded again. 3 minutes of pre-oxygenation will be done. Anaesthesia will be induced with inj. propofol 2mg/kg body weight injected over 30 seconds. Blood pressures will be noted at induction with propofol and for every minute till 5 minutes after induction. Muscle relaxation will be achieved by inj. vecuronium. Patient will be ventilated with oxygen for 5 minutes. Orotracheal intubation will be performed with appropriate sized endotracheal tube. Hypotension will be defined as a drop in systolic blood pressure to less than 30% of baseline values or to MAP <60mm Hg. Incidence of hypotension will be noted.	8 minutes after intubation	No
Primary	incidence of hypotension at 9 minutes after intubation	Patient will be shifted to operation theatre. Non-invasive blood pressure (NIBP) monitor will be attached. Baseline blood pressure including systolic, diastolic and mean arterial blood pressures will be noted. Analgesia will be given by inj fentanyl. Lower limbs will be elevated, wrapped or none according to group allocation. Blood pressures will be recorded again. 3 minutes of pre-oxygenation will be done. Anaesthesia will be induced with inj. propofol 2mg/kg body weight injected over 30 seconds. Blood pressures will be noted at induction with propofol and for every minute till 5 minutes after induction. Muscle relaxation will be achieved by inj. vecuronium. Patient will be ventilated with oxygen for 5 minutes. Orotracheal intubation will be performed with appropriate sized endotracheal tube. Hypotension will be defined as a drop in systolic blood pressure to less than 30% of baseline values or to MAP <60mm Hg. Incidence of hypotension will be noted.	9 minutes after intubation	No
Primary	incidence of hypotension at 10 minutes after intubation	Patient will be shifted to operation theatre. Non-invasive blood pressure (NIBP) monitor will be attached. Baseline blood pressure including systolic, diastolic and mean arterial blood pressures will be noted. Analgesia will be given by inj fentanyl. Lower limbs will be elevated, wrapped or none according to group allocation. Blood pressures will be recorded again. 3 minutes of pre-oxygenation will be done. Anaesthesia will be induced with inj. propofol 2mg/kg body weight injected over 30 seconds. Blood pressures will be noted at induction with propofol and for every minute till 5 minutes after induction. Muscle relaxation will be achieved by inj. vecuronium. Patient will be ventilated with oxygen for 5 minutes. Orotracheal intubation will be performed with appropriate sized endotracheal tube. Hypotension will be defined as a drop in systolic blood pressure to less than 30% of baseline values or to MAP <60mm Hg. Incidence of hypotension will be noted.	10 minutes after intubation	No
Secondary	Magnitude of change in systolic blood pressure from baseline at 0 minutes after leg leg elevation or wrapping	Patient will be shifted to operation theatre. Non-invasive blood pressure (NIBP) monitor will be attached. Baseline systolic blood pressure will be noted. Analgesia will be given by inj fentanyl. Lower limbs will be elevated, wrapped or none according to group allocation. Systolic blood pressure will be recorded again. 3 minutes of pre-oxygenation will be done. Anaesthesia will be induced with inj. propofol 2mg/kg body weight injected over 30 seconds. Systolic blood pressure will be noted at induction with propofol and for every minute till 5 minutes after induction. Muscle relaxation will be achieved by inj. vecuronium. Patient will be ventilated with oxygen for 5 minutes. Orotracheal intubation will be performed with appropriate sized endotracheal tube. Systolic blood pressure will be recorded every minute till 10 min post intubation. Magnitude of change in systolic blood pressure from baseline will be noted	baseline, after leg elevation or wrapping	No
Secondary	Magnitude of change in systolic blood pressure from baseline at 0 minutes after induction	Patient will be shifted to operation theatre. Non-invasive blood pressure (NIBP) monitor will be attached. Baseline systolic blood pressure will be noted. Analgesia will be given by inj fentanyl. Lower limbs will be elevated, wrapped or none according to group allocation. Systolic blood pressure will be recorded again. 3 minutes of pre-oxygenation will be done. Anaesthesia will be induced with inj. propofol 2mg/kg body weight injected over 30 seconds. Systolic blood pressure will be noted at induction with propofol and for every minute till 5 minutes after induction. Muscle relaxation will be achieved by inj. vecuronium. Patient will be ventilated with oxygen for 5 minutes. Orotracheal intubation will be performed with appropriate sized endotracheal tube. Systolic blood pressure will be recorded every minute till 10 min post intubation. Magnitude of change in systolic blood pressure from baseline will be noted	baseline, at 0 minutes after induction with propofol	No
Secondary	Magnitude of change in systolic blood pressure from baseline at 1 minute after induction	Patient will be shifted to operation theatre. Non-invasive blood pressure (NIBP) monitor will be attached. Baseline systolic blood pressure will be noted. Analgesia will be given by inj fentanyl. Lower limbs will be elevated, wrapped or none according to group allocation. Systolic blood pressure will be recorded again. 3 minutes of pre-oxygenation will be done. Anaesthesia will be induced with inj. propofol 2mg/kg body weight injected over 30 seconds. Systolic blood pressure will be noted at induction with propofol and for every minute till 5 minutes after induction. Muscle relaxation will be achieved by inj. vecuronium. Patient will be ventilated with oxygen for 5 minutes. Orotracheal intubation will be performed with appropriate sized endotracheal tube. Systolic blood pressure will be recorded every minute till 10 min post intubation. Magnitude of change in systolic blood pressure from baseline will be noted	baseline, at 1 minute after induction with propofol	No
Secondary	Magnitude of change in systolic blood pressure from baseline at 2 minutes after induction	Patient will be shifted to operation theatre. Non-invasive blood pressure (NIBP) monitor will be attached. Baseline systolic blood pressure will be noted. Analgesia will be given by inj fentanyl. Lower limbs will be elevated, wrapped or none according to group allocation. Systolic blood pressure will be recorded again. 3 minutes of pre-oxygenation will be done. Anaesthesia will be induced with inj. propofol 2mg/kg body weight injected over 30 seconds. Systolic blood pressure will be noted at induction with propofol and for every minute till 5 minutes after induction. Muscle relaxation will be achieved by inj. vecuronium. Patient will be ventilated with oxygen for 5 minutes. Orotracheal intubation will be performed with appropriate sized endotracheal tube. Systolic blood pressure will be recorded every minute till 10 min post intubation. Magnitude of change in systolic blood pressure from baseline will be noted	baseline, at 2 minutes after induction with propofol	No
Secondary	Magnitude of change in systolic blood pressure from baseline at 3 minutes after induction	Patient will be shifted to operation theatre. Non-invasive blood pressure (NIBP) monitor will be attached. Baseline systolic blood pressure will be noted. Analgesia will be given by inj fentanyl. Lower limbs will be elevated, wrapped or none according to group allocation. Systolic blood pressure will be recorded again. 3 minutes of pre-oxygenation will be done. Anaesthesia will be induced with inj. propofol 2mg/kg body weight injected over 30 seconds. Systolic blood pressure will be noted at induction with propofol and for every minute till 5 minutes after induction. Muscle relaxation will be achieved by inj. vecuronium. Patient will be ventilated with oxygen for 5 minutes. Orotracheal intubation will be performed with appropriate sized endotracheal tube. Systolic blood pressure will be recorded every minute till 10 min post intubation. Magnitude of change in systolic blood pressure from baseline will be noted	baseline, at 3 minutes after induction with propofol	No
Secondary	Magnitude of change in systolic blood pressure from baseline at 4 minutes after induction	Patient will be shifted to operation theatre. Non-invasive blood pressure (NIBP) monitor will be attached. Baseline systolic blood pressure will be noted. Analgesia will be given by inj fentanyl. Lower limbs will be elevated, wrapped or none according to group allocation. Systolic blood pressure will be recorded again. 3 minutes of pre-oxygenation will be done. Anaesthesia will be induced with inj. propofol 2mg/kg body weight injected over 30 seconds. Systolic blood pressure will be noted at induction with propofol and for every minute till 5 minutes after induction. Muscle relaxation will be achieved by inj. vecuronium. Patient will be ventilated with oxygen for 5 minutes. Orotracheal intubation will be performed with appropriate sized endotracheal tube. Systolic blood pressure will be recorded every minute till 10 min post intubation. Magnitude of change in systolic blood pressure from baseline will be noted	baseline, at 4 minutes after induction with propofol	No
Secondary	Magnitude of change in systolic blood pressure from baseline at 5 minutes after induction	Patient will be shifted to operation theatre. Non-invasive blood pressure (NIBP) monitor will be attached. Baseline systolic blood pressure will be noted. Analgesia will be given by inj fentanyl. Lower limbs will be elevated, wrapped or none according to group allocation. Systolic blood pressure will be recorded again. 3 minutes of pre-oxygenation will be done. Anaesthesia will be induced with inj. propofol 2mg/kg body weight injected over 30 seconds. Systolic blood pressure will be noted at induction with propofol and for every minute till 5 minutes after induction. Muscle relaxation will be achieved by inj. vecuronium. Patient will be ventilated with oxygen for 5 minutes. Orotracheal intubation will be performed with appropriate sized endotracheal tube. Systolic blood pressure will be recorded every minute till 10 min post intubation. Magnitude of change in systolic blood pressure from baseline will be noted	baseline, at 5 minutes after induction with propofol	No
Secondary	Magnitude of change in systolic blood pressure from baseline at 0 minutes after intubation	Patient will be shifted to operation theatre. Non-invasive blood pressure (NIBP) monitor will be attached. Baseline systolic blood pressure will be noted. Analgesia will be given by inj fentanyl. Lower limbs will be elevated, wrapped or none according to group allocation. Systolic blood pressure will be recorded again. 3 minutes of pre-oxygenation will be done. Anaesthesia will be induced with inj. propofol 2mg/kg body weight injected over 30 seconds. Systolic blood pressure will be noted at induction with propofol and for every minute till 5 minutes after induction. Muscle relaxation will be achieved by inj. vecuronium. Patient will be ventilated with oxygen for 5 minutes. Orotracheal intubation will be performed with appropriate sized endotracheal tube. Systolic blood pressure will be recorded every minute till 10 min post intubation. Magnitude of change in systolic blood pressure from baseline will be noted	baseline, at 0 minutes after intubation	No
Secondary	Magnitude of change in systolic blood pressure from baseline at 1 minute after intubation	Patient will be shifted to operation theatre. Non-invasive blood pressure (NIBP) monitor will be attached. Baseline systolic blood pressure will be noted. Analgesia will be given by inj fentanyl. Lower limbs will be elevated, wrapped or none according to group allocation. Systolic blood pressure will be recorded again. 3 minutes of pre-oxygenation will be done. Anaesthesia will be induced with inj. propofol 2mg/kg body weight injected over 30 seconds. Systolic blood pressure will be noted at induction with propofol and for every minute till 5 minutes after induction. Muscle relaxation will be achieved by inj. vecuronium. Patient will be ventilated with oxygen for 5 minutes. Orotracheal intubation will be performed with appropriate sized endotracheal tube. Systolic blood pressure will be recorded every minute till 10 min post intubation. Magnitude of change in systolic blood pressure from baseline will be noted	baseline, at 1 minute after intubation	No
Secondary	Magnitude of change in systolic blood pressure from baseline at 2 minutes after intubation	Patient will be shifted to operation theatre. Non-invasive blood pressure (NIBP) monitor will be attached. Baseline systolic blood pressure will be noted. Analgesia will be given by inj fentanyl. Lower limbs will be elevated, wrapped or none according to group allocation. Systolic blood pressure will be recorded again. 3 minutes of pre-oxygenation will be done. Anaesthesia will be induced with inj. propofol 2mg/kg body weight injected over 30 seconds. Systolic blood pressure will be noted at induction with propofol and for every minute till 5 minutes after induction. Muscle relaxation will be achieved by inj. vecuronium. Patient will be ventilated with oxygen for 5 minutes. Orotracheal intubation will be performed with appropriate sized endotracheal tube. Systolic blood pressure will be recorded every minute till 10 min post intubation. Magnitude of change in systolic blood pressure from baseline will be noted	baseline, at 2 minutes after intubation	No
Secondary	Magnitude of change in systolic blood pressure from baseline at 3 minutes after intubation	Patient will be shifted to operation theatre. Non-invasive blood pressure (NIBP) monitor will be attached. Baseline systolic blood pressure will be noted. Analgesia will be given by inj fentanyl. Lower limbs will be elevated, wrapped or none according to group allocation. Systolic blood pressure will be recorded again. 3 minutes of pre-oxygenation will be done. Anaesthesia will be induced with inj. propofol 2mg/kg body weight injected over 30 seconds. Systolic blood pressure will be noted at induction with propofol and for every minute till 5 minutes after induction. Muscle relaxation will be achieved by inj. vecuronium. Patient will be ventilated with oxygen for 5 minutes. Orotracheal intubation will be performed with appropriate sized endotracheal tube. Systolic blood pressure will be recorded every minute till 10 min post intubation. Magnitude of change in systolic blood pressure from baseline will be noted	baseline, at 3 minutes after intubation	No
Secondary	Magnitude of change in systolic blood pressure from baseline at 4 minutes after intubation	Patient will be shifted to operation theatre. Non-invasive blood pressure (NIBP) monitor will be attached. Baseline systolic blood pressure will be noted. Analgesia will be given by inj fentanyl. Lower limbs will be elevated, wrapped or none according to group allocation. Systolic blood pressure will be recorded again. 3 minutes of pre-oxygenation will be done. Anaesthesia will be induced with inj. propofol 2mg/kg body weight injected over 30 seconds. Systolic blood pressure will be noted at induction with propofol and for every minute till 5 minutes after induction. Muscle relaxation will be achieved by inj. vecuronium. Patient will be ventilated with oxygen for 5 minutes. Orotracheal intubation will be performed with appropriate sized endotracheal tube. Systolic blood pressure will be recorded every minute till 10 min post intubation. Magnitude of change in systolic blood pressure from baseline will be noted	baseline, at 4 minutes after intubation	No
Secondary	Magnitude of change in systolic blood pressure from baseline at 5 minutes after intubation	Patient will be shifted to operation theatre. Non-invasive blood pressure (NIBP) monitor will be attached. Baseline systolic blood pressure will be noted. Analgesia will be given by inj fentanyl. Lower limbs will be elevated, wrapped or none according to group allocation. Systolic blood pressure will be recorded again. 3 minutes of pre-oxygenation will be done. Anaesthesia will be induced with inj. propofol 2mg/kg body weight injected over 30 seconds. Systolic blood pressure will be noted at induction with propofol and for every minute till 5 minutes after induction. Muscle relaxation will be achieved by inj. vecuronium. Patient will be ventilated with oxygen for 5 minutes. Orotracheal intubation will be performed with appropriate sized endotracheal tube. Systolic blood pressure will be recorded every minute till 10 min post intubation. Magnitude of change in systolic blood pressure from baseline will be noted	baseline, at 5 minutes after intubation	No
Secondary	Magnitude of change in systolic blood pressure from baseline at 6 minutes after intubation	Patient will be shifted to operation theatre. Non-invasive blood pressure (NIBP) monitor will be attached. Baseline systolic blood pressure will be noted. Analgesia will be given by inj fentanyl. Lower limbs will be elevated, wrapped or none according to group allocation. Systolic blood pressure will be recorded again. 3 minutes of pre-oxygenation will be done. Anaesthesia will be induced with inj. propofol 2mg/kg body weight injected over 30 seconds. Systolic blood pressure will be noted at induction with propofol and for every minute till 5 minutes after induction. Muscle relaxation will be achieved by inj. vecuronium. Patient will be ventilated with oxygen for 5 minutes. Orotracheal intubation will be performed with appropriate sized endotracheal tube. Systolic blood pressure will be recorded every minute till 10 min post intubation. Magnitude of change in systolic blood pressure from baseline will be noted	baseline, at 6 minutes after intubation	No
Secondary	Magnitude of change in systolic blood pressure from baseline at 7 minutes after intubation	Patient will be shifted to operation theatre. Non-invasive blood pressure (NIBP) monitor will be attached. Baseline systolic blood pressure will be noted. Analgesia will be given by inj fentanyl. Lower limbs will be elevated, wrapped or none according to group allocation. Systolic blood pressure will be recorded again. 3 minutes of pre-oxygenation will be done. Anaesthesia will be induced with inj. propofol 2mg/kg body weight injected over 30 seconds. Systolic blood pressure will be noted at induction with propofol and for every minute till 5 minutes after induction. Muscle relaxation will be achieved by inj. vecuronium. Patient will be ventilated with oxygen for 5 minutes. Orotracheal intubation will be performed with appropriate sized endotracheal tube. Systolic blood pressure will be recorded every minute till 10 min post intubation. Magnitude of change in systolic blood pressure from baseline will be noted	baseline, at 7 minutes after intubation	No
Secondary	Magnitude of change in systolic blood pressure from baseline at 8 minutes after intubation	Patient will be shifted to operation theatre. Non-invasive blood pressure (NIBP) monitor will be attached. Baseline systolic blood pressure will be noted. Analgesia will be given by inj fentanyl. Lower limbs will be elevated, wrapped or none according to group allocation. Systolic blood pressure will be recorded again. 3 minutes of pre-oxygenation will be done. Anaesthesia will be induced with inj. propofol 2mg/kg body weight injected over 30 seconds. Systolic blood pressure will be noted at induction with propofol and for every minute till 5 minutes after induction. Muscle relaxation will be achieved by inj. vecuronium. Patient will be ventilated with oxygen for 5 minutes. Orotracheal intubation will be performed with appropriate sized endotracheal tube. Systolic blood pressure will be recorded every minute till 10 min post intubation. Magnitude of change in systolic blood pressure from baseline will be noted	baseline, at 8 minutes after intubation	No
Secondary	Magnitude of change in systolic blood pressure from baseline at 9 minutes after intubation	Patient will be shifted to operation theatre. Non-invasive blood pressure (NIBP) monitor will be attached. Baseline systolic blood pressure will be noted. Analgesia will be given by inj fentanyl. Lower limbs will be elevated, wrapped or none according to group allocation. Systolic blood pressure will be recorded again. 3 minutes of pre-oxygenation will be done. Anaesthesia will be induced with inj. propofol 2mg/kg body weight injected over 30 seconds. Systolic blood pressure will be noted at induction with propofol and for every minute till 5 minutes after induction. Muscle relaxation will be achieved by inj. vecuronium. Patient will be ventilated with oxygen for 5 minutes. Orotracheal intubation will be performed with appropriate sized endotracheal tube. Systolic blood pressure will be recorded every minute till 10 min post intubation. Magnitude of change in systolic blood pressure from baseline will be noted	baseline, at 9 minutes after intubation	No