The Effect of Induction of Anesthesia in the Leg-Elevation Position and Head-Down Position Versus Supine Position on the Incidence of Post-Induction Hypotension in Non-Cardiac Surgery: A Randomized Controlled Trial

Abstract

Background: Induction of general anesthesia is associated with hypotension in nearly 50% of surgical patients. Intraoperative hypotension leads to ischemia of vital organs and increases the risk of preoperative mortality; therefore, meticulous hemodynamic management to avoid pre-incision hypotension is essential to avoid serious outcomes.Various methods are used for the prevention of post-induction hypotension such as preoperative fluid loading and vasopressors. The use of positioning protocols to augment venous return would provide a non-pharmacological option for maintaining the hemodynamic profile without the need for excessive fluids and vasopressors. Aim of Study:In this study, we aimed to evaluate the efficacy of leg-elevation position and head-down position compared to supine position during induction of anaesthesia in reducing post-induction hypotension.Patients and Methods: This study included adult patients scheduled for elective noncardiac surgery under general anaesthesia. Before induction of anesthesia, patients were randomly allocated into three groups who started induction of anesthesia in either supine position, leg-elevation position, or head-down position. Blood pressure and heart rate were recorded at 1-minute intervals after induction of anesthesia till 15-minutes after intubation. Our primary outcome was the incidence of post-induction hypotension (defined as systolic blood pressure <80% of the baseline reading). Other outcomes included systolic blood pressure, heart rate, and norepinephrine consumption.Results: One-hundred and twenty-one patients were available for the final analysis. The incidence of post-induction hypotension was lower in each of leg-elevation group (18/41 [44%] patients) and head-down group (16/40 [40%] patients) compared to the control group (32/40 [80%] patients) (p-values <0.001 and <0.001) without significant difference between the