Active clinical trials for "Hypotension"

The investigators aimed to investigate the deep learning model to predict intraoperative hypotension using non-invasive monitoring parameters.

We include patient who will undergo elective surgeries such as orthopedic surgeries as fixator placement, lower extremity debridement, inguinal hernia, Urosurgery as bladder- prostate resection, hysterectomy, fibroid removal, ovarian cyct removal, plastic surgeries, and other types of surgery. The fasting durations of the included patients will be 8 hours for solids and 2 hours for clear liquids. There won't be any premedication given. The patient will be placed in a supine, neutral-head resting posture in the operating room as well as standard monitors such as a five-lead electrocardiography, pulse oximeter, and noninvasive blood pressure. An attending anesthesiologist will use a 25-gauge Quincke spinal needle to induce spinal anesthesia in the L3/4 or L4/5 vertebral interspace with the patient in the right lateral decubitus posture. Throughout the course of the trial, the attending anesthesiologist will choose the dosages of 0.5% hyperbaric bupivacaine (10 to 15 mg) and fentanyl (10 to 20 mg) 28. The patient will be placed back in the supine position without any lateral tilt once the spinal injection has been given over a period of 15 to 30 seconds. Three minutes following the spinal injection, the sensory block will be evaluated with a cold and pinprick test. The mean blood pressure will be taken every 3 minutes between the spinal injection and delivery, and every 5 minutes from the delivery until the end of the procedure. The lowest SBP measured between the spinal anesthesia injection and delivery will be determined, together with the percentage of the SBP drop from the pre-anesthetic SBP. The patient's head will be turned 308 degrees to the left. First, a 6.0 to 13.0MHz linear array transducer will be positioned vertically on the neck with the probe marker facing the patient's head. The lower edge of the thyroid cartilage will provide a long-axis B-mode picture of the right common carotid artery. The probe will then be positioned in the lumen's center, around 2 cm from where the carotid arteries split. After that, carotid artery blood flow waveforms will be preserved together with a pulsed Wave-Doppler trace of the artery's flow. The cycle time will be determined by counting the number of heartbeats at the start of the systolic upstroke using an ultrasound machine's caliper function. By taking measurements in one-tenth of millisecond intervals between the systolic upstroke and the diastolic notch, the flow time will be determined. the IVC will be scanned using a portable ultrasound device (LOGIQ-e by GE health care) and a 3.5-5 MHz curvilinear probe in the subxiphoid region (paramedian long-axis view), just close to the common hepatic vein's draining to the IVC. At the point where the IVC joins the right atrium, a 2D picture will be obtained. M-mode imaging will be used to record changes in IVC diameter during inspiration and expiration. The procedure is carried out two to three centimeters away from the right atrium/IVC junction. The attending anesthetist will keep track of how long it took to locate the IVC after placing the probe on the patient. The M mode of the ultrasonography will be used to measure the IVC's Minimum (IVCDMin) and Maximum (IVCDMax) diameters, and the IVC Collapsibility Index (IVCCI) will be calculated.

Comparison of two practices of obstetrical services between the CHU of Clermont Ferrand and the HFME Lyon-Bron in the management of arterial hypotension during an elective cesarean section

PACU-HPI study evaluates the use of a hemodynamic monitor in the post-anesthetic recovery room on patients undergoing colorectal, hepatobiliary, and vascular surgery, to determine the feasibility of recruiting this surgical population.

The two scientific societies FADOI and SIIA have decided to start a collaborative study protocol that, through the application of a simple and homogeneous method to diagnose orthostatic hypotension, aims to estimate prevalence, conditions associates and outcomes in a cohort of patients admitted to Internal Medicine Departments and with known or newly diagnosed arterial hypertension.

Synucleinopathies are a group of rare diseases associated with worsening neurological deficits and the abnormal accumulation of the protein α-synuclein in the nervous system. Onset is usually in late adulthood at age 50 or older. Usually, synucleinopathies present clinically with slowness of movement, coordination difficulties or mild cognitive impairment. Development of these features indicates that abnormal alpha-synuclein deposits have destroyed key areas of the brain involved in the control of movement or cognition. Patients with synucleinopathies and signs of CNS-deficits are frequently diagnosed with Parkinson disease (PD), dementia with Lewy bodies (DLB) or multiple system atrophy (MSA). However, accumulation of alpha-synuclein and death of nerve cells can also begin outside the brain in the autonomic nerves. In such cases, syncucleinopathies present first with symptoms of autonomic impairment (unexplained constipation, urinary difficulties, and sexual dysfunction). In rare cases, hypotension on standing (a disorder known as orthostatic hypotension) may be the only clinical finding. This "pre-motor" autonomic stage suggests that the disease process may not yet have spread to the brain. After a variable period of time, but usually within 5-years, most patients with abnormally low blood pressure on standing develop cognitive or motor abnormalities. This stepwise evolution indicates that the disease spreads from the body to the brain. Another indication of this spread is that acting out dreams (i.e., REM sleep behavior disorder, RBD) a problem that occurs when the lower part of the brain is affected, may also be the first noticeable sign of Parkinson disease. The purpose of this study is to document the clinical features and biological markers of patients with synucleinopathies and better understand how these disorders evolve over time. The study will involve following patients diagnosed with a synucleinopathy (PD/DLB and MSA) and those believed to be in the "pre-motor" stage (with isolated autonomic impairment and/or RBD). Through a careful series of follow-up visits to participating Centers, we will focus on finding biological clues that predict which patients will develop motor/cognitive problems and which ones have the resilience to keep the disease at bay preventing spread to the brain. We will also define the natural history of MSA - the most aggressive of the synucleinopathies.

The primary objective of this observational study is to investigate the risk factors for intraoperative hypotension and identify the underlying pathomechanisms leading to it, both during the period after general anesthesia induction and throughout its course. The main questions it aims to answer are: how frequent is intraoperative hypotension what are the underlying pathomechanism causing it The study is including patients who have been identified as having a high risk of perioperative complications (ASA3 or ASA4). Patients included in the study undergo advanced hemodynamic monitoring during the procedure. Anesthesia induction, maintenance, and termination are conducted by an anesthesiologist in accordance with current medical knowledge, and the planned experiment does not in any way influence the course of action. Investigators will analyse medical documentation, including the patient's medical history, anesthesia records, and hemodynamic parameter data obtained from the hemodynamic monitor (an Excel file containing comprehensive data related to specific cardiovascular parameters) to describe the incidence of intraoperative hypotension and answer key questions in accordance with the designed study protocol.

The aim of our study is to determine the predictive value of pre-anesthesia FTc for hypotension that may develop after general anesthesia induction in patients over 65 years of age and to investigate the correlation between pre-anesthesia FTc and the magnitude of the maximum decrease in systolic blood pressure from the pre-anaesthetic value.

With the progression of population aging, the number of elderly patients undergoing surgery is increasing as well. However, as the condition of health differs greatly between individual elderly patients even of the same age, it is a necessity to evaluate elderly patients thoroughly and individually for better management of perioperative care. Frailty is a condition in which patients are impaired at physical reserve and homeostatic control. Frail elderly people are at higher risk of morbidity and mortality after exposure to a stressor. Frail patients are at higher risk of perioperative complications and longer hospital stay. However, there has been no standard criteria or tool to evaluate frailty in the elderly. Neither has there been enough evidence explaining the mechanism between frailty and increased perioperative complications. Therefore, in this study we aim to discover the relationship between frailty and intraoperative hemodynamic instability, as well as perioperative complications in the elderly patients, hoping to find an adequate and practical model for preoperative assessment in the elderly hopefully for better perioperative outcome.

Up to today, inadequate evidences and knowledge exist about the best prehospital management of hypotensive trauma patients and its clinical consequence on the in-hospital recovery and mortality. Also new emerging therapies such as prehospital blood transfusion and REBOA (resuscitative endovascular balloon occlusion of the aorta) are lacking strong evidences in, eventually, reducing hospital mortality and improving outcomes. Moreover, prehospital emergency medicine is throughout Italy an heterogeneous system that has no unique standard operating procedures and, even among HEMS (helicopter emergency medical service), management and therapies on complex trauma patients may vary upon local policies. With this study we aim to enroll hypotensive trauma patients and study factors of prehospital rescue that can be associated with in-hospital mortality and recovery, eventually even with hospital outcome. For each patients data as demographic, kind of trauma (mechanism, injury scores), therapies and maneuvers will be recorded and then analyzed in comparison with in-hospital data such as need for transfusion, ABG parameters, length of stay (in-ward and ICU), need of therapies like invasive ventilation and renal replacement therapy, recovery and outcome