Carotid ultrasound to predict low blood pressure during anesthesia in adults with chronic liver disease

Carotid Artery Corrected Flow Time and Respiratory Variation of Blood Flow Peak Velocity for Prediction of Hypotension After Induction of General Anaesthesia in Adult Patients With Chronic Liver Disease

We will test if carotid ultrasound timing and breathing-related changes in blood flow can predict low blood pressure during and for 10 minutes after induction of general anesthesia in adults with chronic liver disease having elective surgery.

Quick facts

• Study type: Observational
• Enrollment: 35 (estimated)
• Ages: 18 Years and up
• Sex: All
• Sponsor: Ain Shams University (Academic / other)
• Locations: 1 site (Cairo)
• Trial ID: NCT07370103 on ClinicalTrials.gov

What this trial studies

Before anesthesia, investigators take three carotid ultrasound readings in the supine position and average measures of corrected flow time and respiratory variation of peak velocity. During induction and for 10 minutes afterward, heart rate (ECG), SpO2, end-tidal CO2, and invasive arterial blood pressure from a radial artery catheter are recorded continuously. The observational protocol enrolls adults with chronic liver disease scheduled for elective general anesthesia (ASA 2–4, BMI ≤30) and excludes patients with significant cardiac disease, carotid stenosis, emergency surgery, or MAP <65 mmHg. Pre-induction carotid ultrasound markers will be correlated with the occurrence of hypotension after induction to see if they predict risk.

Who should consider this trial

Good fit: Adults (≥18) with chronic liver disease scheduled for elective surgery under general anesthesia who are ASA class 2–4, have BMI ≤30, no carotid stenosis or prior neck surgery, and baseline MAP between 65 and 120 mmHg.

Not a fit: Patients with known severe cardiac disease, carotid artery stenosis or anatomical issues preventing ultrasound, BMI >30, emergency surgery, baseline MAP <65 mmHg, or current ACE inhibitor/ARB therapy are unlikely to benefit or be eligible.

Why it matters

Potential benefit: If successful, the approach could let clinicians identify patients at higher risk of low blood pressure at induction so they can take preventive steps and reduce complications.

How similar studies have performed: Previous studies in general surgical and critical care populations have shown carotid corrected flow time and respiratory variation may predict fluid responsiveness or hypotension, but their use specifically in chronic liver disease is relatively novel and less well validated.

Eligibility criteria

Inclusion Criteria:

* • Adult patients (≥ 18 years) with a confirmed diagnosis of CLD (e.g., cirrhosis, non-alcoholic steatohepatitis)

  * scheduled for elective surgery under general anesthesia.
  * ASA 2,3,4
  * ASA 4 patients will be included only if their baseline MAP is \>65 mmHg, as per the exclusion criteria

Exclusion Criteria:

* • Refusal to participate

  * Patients with known cardiac disease (e.g., severe valvular disease, congestive heart failure),
  * pre-existing severe hypotension (e.g., mean arterial pressure \<65 mmHg
  * emergency surgery
  * anatomical variations preventing adequate ultrasound visualization of the carotid artery.
  * Carotid artery stenosis.
  * Mean arterial pressure (MAP) \> 120 mmHg before anesthesia
  * any previous record of neck surgery or trauma.
  * acute renal injury.
  * oral angiotensin receptor blockers or angiotensin-converting enzyme inhibitors (ACEI)
  * lateral, prone, and lithotomy operations
  * body mass index (BMI) \> 30 kg/m2 or \< 15 kg/m2

Where this trial is running

Cairo

• Ainshams University — Cairo, Egypt (Recruiting)

Study contacts

• Study coordinator: ismail mohammed mahmoud, assistant professor

Conditions Hypotension on Induction; carotid time,respiratory variation,hypotension,chronic liver disease