2026· Asian Journal of Medical Research and Health Sciences· Vol 04, pp. 440-446· 0 citations
TL;DR
Controlled hypertensive patients experience greater hemodynamic instability following spinal anaesthesia compared to normotensive individuals, with higher incidence and earlier onset of hypotension and increased vasopressor requirement.
Abstract
Introduction: Spinal anaesthesia commonly causes hypotension due to sympathetic blockade. Controlled hypertensive patients may exhibit altered cardiovascular responses because of vascular and autonomic changes. Evidence comparing hypertensive and normotensive patients remains inconsistent. This study aimed to comparatively evaluate hemodynamic changes following spinal anaesthesia to improve perioperative risk stratification and management.Material and Method: This comparative observational study included 120 American Society of Anesthesiologists physical status (ASA) I–III patients (40–75 years) undergoing elective infraumbilical surgeries under spinal anaesthesia. Patients were grouped as controlled hypertensive or normotensive. Standardized spinal technique and monitoring were used. Hemodynamic variables were recorded up to 30 minutes. Hypotension was predefined and managed accordingly. Statistical analysis included t-test, ANOVA, Chi-square, and Pearson correlation.Result:A total of 120 patients undergoing spinal anaesthesiawere studied i.e. 60 Controlled hypertensive patients (CHT) and 60 normotensive (NT) with comparable demographics and surgical characteristics. Controlled hypertensive patients had higher baseline mean arterial pressure, systolic and diastolic blood pressure and experienced greater maximum hemodynamic declines. Hypotension (48.3% vs 28.3%) and vasopressor requirement were significantly higher in CHT patients. Advanced age, elevated baseline pressures, higher sensory block, increased body mass index (BMI), and longer surgery predicted hypotension.Conclusion: Controlled hypertensive patients experience greater hemodynamic instability following spinal anaesthesia compared to normotensive individuals, with higher incidence and earlier onset of hypotension and increased vasopressor requirement. Careful monitoring and individualized perioperative management are essential to improve safety and outcomes.
Objective: To determine the mean hemodynamic changes with etomidate and propofol during anaesthetic induction in controlled hypertensive patients.
Study Design: Quasi experimental study.
Place and Duration of Study: Anaesthesia Department, Combined Military Hospital Malir, Karachi, Pakistan from Mar 2019 to Mar 2020.
Methodology: After permission from the Institutional Ethical Review Committee, a sample size of 70 controlled hypertensive patient sundergoing surgery under general anaesthesia of ages between 30-60 years of either gender were included in the study and placed in two groups. Group-A included those who were given injection propofol and Group-B consisted of those who received injection etomidate. Determination of mean hemodynamic changes with propofol in comparison with etomidate during induction of anaesthesia was the primary outcome. Results recorded and analyzed thereafter for conclusion.
Results: The mean variation of heart rate (HR) in Group-A and Group-B was 76.80±7.74 bpm and 79.49±9.33 bpm respectively. Mean variation in systolic blood pressure (SBP) was 130.14±13.30 mm of Hg and 137.09±13.66 mm of Hg. Mean diastolic blood pressure (DBP) between propofol and etomidate was 76.80±7.74 mm of Hg and 79.49±9.33 mm of Hg. The analysis between two groups was made keeping in mind the variables of HR, SBP and DBP. It showed etomidate was a better choice for induction.
Conclusion: We concluded that hemodynamic control is better with etomidate than propofol during induction of anaesthesia in controlled hypertensive patients.
Muhammad Wasib, U. Khalid, F. Wahid et al.· Pakistan Armed Forces Medica...· 0 citations
Background: Post-induction hypotension is a frequent complication of general anesthesia and may reflect inadequate cardiovascular compensation to anesthetic-induced vasodilation. Preoperative assessment of autonomic reserve may identify patients at increased risk.
Methods: This prospective observational study included 111 adults undergoing elective surgery under general anesthesia at Sri Lakshmi Narayana Institute of Medical Sciences, Puducherry from May 2024 to May 2025. Preoperative autonomic reserve was assessed using short-term heart rate variability and standardized cardiovascular autonomic tests. Hemodynamic variables were recorded for 10 minutes following induction. Post-induction instability was defined by a reduction in mean arterial pressure of at least 20% from baseline or MAP below 65 mmHg.
Results: Hemodynamic instability occurred in 39 patients (35.1%). These patients demonstrated significantly lower SDNN, RMSSD, high-frequency power, deep-breathing E:I ratio, and 30:15 ratio, with higher LF/HF ratio and greater orthostatic systolic pressure reduction. Vasopressor requirement was also higher. Lower SDNN, two or more abnormal autonomic tests, and lower baseline MAP independently predicted instability. The combined predictive model achieved an AUROC of 0.82.
Conclusion: Reduced preoperative autonomic reserve was strongly associated with post-induction hemodynamic instability. Simple autonomic assessment may improve perioperative risk stratification and facilitate individualized hemodynamic preparedness before general anesthesia, particularly in patients with otherwise apparently acceptable baseline cardiovascular parameters.
Keywords: Autonomic reserve; General anesthesia; Heart rate variability; Hemodynamic instability; Post-induction hypotension.
Neeraj Kumar, Praveen Dm· Journal of Toxicology and Me...· 0 citations
BACKGROUND
Spinal anesthesia-induced hypotension (SAIH) is common in hypertensive patients, yet reliable preoperative markers remain limited. Corrected carotid flow time (CCFT) is a Doppler-derived index influenced by preload and ventricular ejection timing, but its association with SAIH in this population has not been established.
OBJECTIVE
To evaluate whether preoperative CCFT is independently associated with SAIH in hypertensive patients undergoing spinal anesthesia.
DESIGN
Single-center prospective observational study.
SETTING
University hospital, operating room.
PATIENTS
110 hypertensive adults scheduled for lower abdominal or lower extremity surgery under spinal anesthesia.
INTERVENTIONS
Preoperative carotid and brachial ultrasound assessments (CCFT, carotid intima-media thickness [CIMT], flow-mediated dilation [FMD], carotid blood flow [CBF], and internal jugular vein collapsibility index [IJV-CI]) were performed. Hemodynamics were recorded for 30 minutes after spinal injection.
MAIN OUTCOME MEASURES
Primary outcome: SAIH (≥20% decrease in systolic blood pressure or SBP <90 mmHg sustained for ≥1 minute).
SECONDARY OUTCOMES
hemodynamic trends and discriminative performance of ultrasound parameters.
RESULTS
SAIH occurred in 54 patients (49.1%). CCFT was shorter in patients who developed hypotension (326.5±71.3 vs. 437.3±82.9 ms, p<0.001). In the primary multivariable model including CIMT, FMD, and beta-blocker use, CCFT remained independently associated with SAIH (aOR 0.980 per 1-ms increase, 95% CI 0.973-0.988, p<0.001). CCFT alone had an AUC of 0.854 (95% CI 0.785-0.924); the 358.5-ms cut-off had 74.1% sensitivity and 87.5% specificity. A clinical model including age, baseline SBP, and beta-blocker use had an AUC of 0.572 (95% CI 0.465-0.679); adding CCFT increased the AUC to 0.866 (95% CI 0.799-0.932; paired comparison p<0.001).
CONCLUSIONS
Preoperative CCFT was independently associated with SAIH and improved discrimination when added to a parsimonious clinical model. The cohort-derived threshold requires external validation before clinical implementation.
TRIAL REGISTRATION
ClinicalTrials.gov (https://clinicaltrials.gov/), NCT06749184.
M. Tutar, Hasan Mermer, Ali Aydin Oner et al.· Journal of Investigative Med...· 0 citations
Background: Intravenous induction agents play a vital role in maintaining hemodynamic stability during general anesthesia. Propofol is commonly preferred because of its rapid onset and smooth recovery profile, although it frequently causes hypotension and cardiovascular depression. Etomidate is considered more hemodynamically stable and is often used in patients with compromised cardiovascular status. Aim: To assess and compare the hemodynamic changes and recovery profile following induction of general anesthesia using propofol and etomidate.Materials and Methods: A prospective comparative study was conducted among 120 adult patients undergoing elective surgeries under general anesthesia. Patients were randomly dividedinto two groups of 60 each. Group A received propofol 2 mg/kg intravenously, while Group B received etomidate 0.3 mg/kg intravenously for induction. Hemodynamic parameters including heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) were recorded at baseline, after induction, and after intubation. Recovery profile and adverse effects were also evaluated.Results: Group B demonstrated significantly greater hemodynamic stability compared to Group A. The reduction in MAP after induction was significantly higher in Group A (p<0.001). Recovery time was shorter in Group A than Group B (p<0.05). Injection pain was more common in Group A, whereas myoclonus was observed predominantly in Group B.Conclusion:Etomidate provided superior hemodynamic stability during induction of general anesthesia, whereas propofol showed a faster recovery profile. Etomidate may be considered a safer induction agent in patients where cardiovascular stability is a major concern.
Dr. Payal Uikey, Dr. Pravin Kanoje, Dr. Syed Zeb Raza· Asian Journal of Medical Res...· 0 citations
Perioperative hemodynamic instability is a major concern in hypertensive patients undergoing general anesthesia. Nearly 45% of these patients require dual antihypertensive therapy, yet the perioperative effects of specific drug combinations remain poorly defined. While single-agent effects are well documented, data on dual regimens are limited, particularly regarding hypotension duration and recovery. This study compared hemodynamic responses across five commonly used dual antihypertensive combinations.
A prospective observational study was conducted in hypertensive patients aged 35–70 years (American society of anesthesiologist grading (ASA) II/III) on dual therapy scheduled for elective surgery. Patients were grouped into angiotensin II receptor blocker (ARB) + diuretic, angiotensin-converting enzyme inhibitor (ACEI) + diuretic, ACEI + calcium channel blocker (CCB), ARB + CCB, and CCB + β-blocker regimens. Hemodynamic parameters were recorded from induction to 30 minutes post-intubation. The primary outcome was hypotension duration; secondary outcomes included incidence of hypotension, vasopressor use, and heart rate (HR) response.
Ninety-three patients were analyzed. Hypotension occurred in 77.4% overall, with no difference in incidence between groups (
P
= 0.330). However, hypotension duration differed significantly (
P
= 0.007), being longest with CCB + β-blocker (12.4 ± 8.1 minutes) and shortest with ACEI + CCB (3.6 ± 1.5 minutes; mean difference 8.7 minutes, 95% CI: 2.24–15.32,
P
= 0.003). Post-laryngoscopy HR rise was significantly more attenuated in ARB + CCB versus ARB + diuretic groups (mean difference 17 bpm,
P
= 0.017).
While dual antihypertensive regimens show similar rates of hypotension, recovery duration varies significantly. CCB + β-blocker combinations are associated with prolonged hypotension, whereas ACEI + CCB regimens recover faster. These findings support individualized perioperative monitoring and drug-specific management strategies.
Pradeep K. Bhatia, Priyanka Sethi, B. Paliwal et al.· Journal of Anaesthesiology C...· 0 citations
Background Pre-anesthesia blood pressure (BP) elevation frequently occurs in normotensive elective surgical patients and may disrupt perioperative safety. This study adopted two mainstream diagnostic criteria (absolute and relative thresholds) to define BP elevation, and integrated physical, laboratory and psychological indicators to systematically explore relevant associated factors. Methods This case-control study enrolling a total of 528 non-cardiac surgical patients. Patients were divided into case (elevated pre-anesthesia BP) and control (normal pre-anesthesia BP) groups. Pre-anesthesia BP elevation was defined as absolute threshold (systolic BP [SBP] ≥140 mmHg and/or diastolic BP [DBP] ≥90 mmHg), and relative threshold (≥20% increase from baseline). Multivariable logistic regression was used to screen associated factors. Results The incidence of pre-anesthesia BP elevation was 35.6% (n=188) under the absolute threshold and 28.2% (n=149) under the relative threshold. Multivariable analysis revealed that increasing age (absolute threshold: odds ratio [OR] 1.08, 95% confidence interval [CI] 1.05–1.10, relative threshold: OR 1.03, 95% CI 1.01–1.04), hyperlipemia (absolute threshold: OR 2.66, 95% CI 1.84–3.86, relative threshold: OR 1.49, 95% CI 1.18–1.88) and anxiety (absolute threshold: OR 1.17, 95% CI 1.10–1.25, relative threshold: OR 1.07, 95% CI 1.02–1.13) were correlated with BP elevation under both definitions (all p < 0.01). Under the absolute threshold, body mass index (BMI) (OR 1.12, 95% CI 1.03–1.21) and alcohol drinking (OR 2.74, 95% CI 1.55–4.84) were positively correlated (both p < 0.01), whereas prolonged sleep duration (2–4 hours: OR 0.37, 95% CI 0.15–0.95, 4–6 hours: OR 0.14, 95% CI 0.06–0.35, 6–8 hours: OR 0.12, 95% CI 0.04–0.34) was negatively correlated (all p < 0.05). Conclusion Increasing age, hyperlipemia and preoperative anxiety are consistently associated with transient pre-anesthesia BP elevation under both criteria. Further studies are required to confirm causal links and verify whether intervening on these correlates can reduce perioperative BP fluctuations.
Xiao-Min Li, Yan Yang, Hao Pan et al.· Risk Management and Healthca...· 0 citations