Methods
depressed left ventricular function, cerebrovascular or peripheral vascular disease, Pain, ’, congenital or valvular heart diseases, agitation, elevated systolic pulmonary arterial pressure, hypotension, Agitation, COPD
UNCONTROLLED HYPERTENSION, MUSCLE RELAXATION, CHRONIC OBSTRUCTIVE PULMONARY DISEASE, MAY, COPD, SECONDARY HYPERTENSION
This prospective, observational study was performed in the Department of Anesthesiaو Intensive Care and Pain Management, Faculty of Medicine, Zagazig University, after Institutional Review Board (IRB) approval (ZUIRB #9424 dated 03-04-2022) and obtaining patients’ informed consent for participation in the study during the period from May 2022 to May 2023. All study procedures were carried out in accordance with the ethical standards of the Helsinki Declaration of 2013.Patients of both sexes who were aged 21–70 y, ASA II or III, had a medical history of controlled hypertension, had a body mass index (BMI) < 35 kg/m2 and underwent elective noncardiac surgery under GA were included in the study.Exclusion criteria included patient refusal, suspected difficult airway, chronic obstructive pulmonary disease (COPD), elevated systolic pulmonary arterial pressure (> 40 mmHg), depressed left ventricular function (EF < 40%), severe congenital or valvular heart diseases, implanted pacemaker/cardioverter defibrillator, current angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) medications, baseline systolic arterial pressure (SAP) ≥ 180 mmHg or < 90 mmHg, secondary hypertension, cerebrovascular or peripheral vascular disease, agitation (Richmond Agitation Sedation Scale (RASS) > + 1) [All patients were thoroughly evaluated and medically optimized through the preoperative preparation outpatient clinic. The IVCCI measurement procedure was explained to the patient on the night of surgery. All patients were premedicated with 10 mg oral diazepam on the night of the surgery. Oral feeding was withheld for 8 h overnight. Clear fluids were allowed until 4 h before induction of GA. Regular antihypertensive medications were continued on their established routine, except for diuretics, which were withheld on the morning of surgery.On patient arrival to the operating room, standard monitoring was applied, including 5-lead ECG, pulse oximetry and a noninvasive oscillometer for blood pressure monitoring (Datex-Ohmeda model (S/S) AN.S. NO:3,422,715, Finland,1998). Invasive arterial blood pressure monitoring was used by the attending anesthetist according to the invasiveness of the planned surgery and the risk level of the patient.Before induction of GA, the IVC was examined while the patient had been spontaneously, quietly breathing and lying in the supine position for at least 5 min before assessment. A two-dimensional image of the IVC as it entered the right atrium was obtained through the paramedian long-axis view via a subcostal approach [Anesthesia was induced using iv propofol 1.5–2 mg/kg and fentanyl 2 µg/kg. Endotracheal intubation was facilitated using cisatracurium 0.15 mg/kg. Anesthesia was maintained using isoflurane in an oxygen-air mixture based on MAC 1.25%. The patient was mechanically ventilated, and end-tidal carbon dioxide (ETCOHypotension after induction of GA was considered if SAP dropped by more than 30% of the baseline value and/or mean arterial pressure (MAP) dropped to < 65 mmHg at any time after induction of GA until 15 min after endotracheal intubation and before the start of any surgical manipulations. If hypotension occurred, arterial blood pressure was measured every 3 min until hypotension subsided. A 250 ml crystalloid bolus was given and repeated as appropriate if MAP < 65 mmHg. Ephedrine 3 mg increments were given if hypotension persisted for ≥ 3 min.At the end of the surgical procedure, anesthesia was discontinued, and muscle relaxation was reversed. The trachea was extubated when extubation criteria had been met.