This observational study aims to learn whether changes in the internal jugular vein during anesthesia induction can help predict low blood pressure and kidney injury after surgery. The main questions it aims to answer are:
1. Can the internal jugular vein collapsibility index before anesthesia predict low blood pressure during induction? 2. Can the change in internal jugular vein collapsibility from before to just after anesthesia predict low blood pressure during surgery and acute kidney injury after surgery?
Participants will have routine ultrasound scans of the neck before anesthesia and again shortly after they fall asleep for surgery. Researchers will also record blood pressure during surgery and measure kidney function after surgery using routine blood tests. and again shortly after they fall asleep for surgery. Researchers will also record blood pressure during surgery and measure kidney function after surgery using routine blood tests.
Elective or Urgent (Non-emergent) major abdominal/ visceral surgery under general anesthesia
General anesthesia with propofol induction (TCI/ manual)
Expected surgical duration > 60 minutes
Continous BP monitoring (Invasive arterial line or non-invasive cuff at 2 minute recording intervals)
Emergency surgery (immediate life-saving, consent unobtainable)
End-stage renal disease (eGFR < 15 mL/min/1.73 m²) or dialysis-dependent
Concomitant cardiac surgery or carotid endarterectomy
Liver transplantation
The study population consists of adults aged 18 years and older undergoing major abdominal or visceral surgery under general anesthesia with propofol induction at the Department of Anestesiology and Intensive Care Department in the Emergency County Hospital in Târgu Mureș. Patients will be enrolled prospectively in the preoperative period if they meet eligibility criteria, have routine perioperative blood pressure monitoring, and are able to undergo internal jugular vein ultrasound before and immediately after induction. The cohort will be followed through postoperative days 1 to 3 for creatinine-based assessment of acute kidney injury.
Cohort
Prospective
Internal Jugular Vein Ultrasound Assesment
Procedure/SurgeryPoint-of-care Internal jugular vein ultrasound performed before induction and immediately after propofol induction to measure vein diameter and collapsibility index.
Post-induction hypotension
Incidence of mean arterial pressure below 65 mmHg for atleast one consecutive minute during propofol induction
Change in Internal Jugular Vein Collapsibility Index
Difference between pre-induction and immediate post-induction internal jugular vein collapsibility index measured by point-of-care ultrasound
Postoperative Acute Kidney Injury
Acute Kidney Injury defined according to KDIGO criteria based on postoperative serum creatinine measurements
Cumulative Intra-operative Hypotension Burden
Total duration of mean arterial pressure threshold of 65 mmHg during the operative period
Cummulative Intra-operative Hypotension burden
Area under the mean arterial pressure threshold of 65 mmHg during the operative period
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