xml: <clinical_study>
    <!-- This xml conforms to an XML Schema at:
      https://clinicaltrials.gov/ct2/html/images/info/public.xsd -->
    <required_header>
      <download_date>ClinicalTrials.gov processed this data on September 20, 2023</download_date>
      <link_text>Link to the current ClinicalTrials.gov record.</link_text>
      <url>https://clinicaltrials.gov/ct2/show/NCT05969886</url>
    </required_header>
    <id_info>
      <org_study_id>32/GCN-HDDD</org_study_id>
      <secondary_id>No: 32/GCN-HDDD</secondary_id>
      <nct_id>NCT05969886</nct_id>
    </id_info>
    <brief_title>Ventricular-Arterial Coupling: A Predictor of Post-Induction Hypotension</brief_title>
    <acronym>VAC</acronym>
    <official_title>Predictive Value of Ventricular-Arterial Coupling for Post-Induction Hypotension: A Prospective Observational Cohort Study</official_title>
    <sponsors>
      <lead_sponsor>
        <agency>University Medical Center Ho Chi Minh City (UMC)</agency>
        <agency_class>Other</agency_class>
      </lead_sponsor>
    </sponsors>
    <source>University Medical Center Ho Chi Minh City (UMC)</source>
    <oversight_info>
      <is_fda_regulated_drug>No</is_fda_regulated_drug>
      <is_fda_regulated_device>No</is_fda_regulated_device>
    </oversight_info>
    <brief_summary>
      <textblock>
        Post-induction hypotension (PIH) is a common occurrence during the period from induction of&#xD;
        general anesthesia to initiation of incision. PIH has been identified as an independent risk&#xD;
        factor for postoperative major complications. Identifying high-risk patients for PIH could&#xD;
        potentially help prevent its occurrence. Several risk factors associated with PIH have been&#xD;
        identified, including patient conditions and use of specific anesthetic agents.&#xD;
        Ventricular-arterial coupling (VAC) is evaluated using the ratio Ea/Ees and represents the&#xD;
        interaction between the left ventricle (LV) and the arterial system. It reflects how changes&#xD;
        in LV contractility (Ees) and changes in arterial load (Ea) work together to maintain optimal&#xD;
        LV performance. A study aims to investigate the relationship between preoperative Ea/Ees&#xD;
        ratio and the incidence of PIH (defined as MAP &lt; 65 mmHg).&#xD;
      </textblock>
    </brief_summary>
    <detailed_description>
      <textblock>
        Post-induction hypotension (PIH) is a common event due to general anesthesia in patients&#xD;
        undergoing surgery. It is described as hypotension occurring during the period from induction&#xD;
        of general anesthesia to initiation of incision. A universal definition of intraoperative&#xD;
        hypotension is lacking, leading to inconsistent rates of occurrence for PIH. According to&#xD;
        Yoshimura et al., PIH occurs in 34% of patients using the mean arterial pressure (MAP)&#xD;
        definition of &lt; 55 mmHg, whereas Maheshwari found PIH in 53% of patients using a MAP&#xD;
        definition of &lt; 65 mmHg. Furthermore, Maheshwari et al. demonstrated that PIH was an&#xD;
        independent risk factor for postoperative major complications such as myocardial injury,&#xD;
        cerebrovascular events, and acute kidney injury.&#xD;
  &#xD;
        If high-risk patients for PIH could be identified we might potentially prevent PIH. In a&#xD;
        systematic review, Chen et al. pointed out that the risk factors associated with PIH were ASA&#xD;
        (American Society of Anesthesiologists) III-V, advanced age, emergency cases, hypovolaemia,&#xD;
        long-term use of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers,&#xD;
        use of propofol and high-dose of opioid. This study suggests that PIH may be the result of an&#xD;
        interaction between the anesthetic agent and the cardiovascular condition of the patient.&#xD;
        Conditions such as moderate-to-severe aortic regurgitation, moderate-to-severe mitral&#xD;
        regurgitation, regional wall motion abnormalities, and echocardiography findings (e.g.&#xD;
        elevated ratio of peak early diastolic transmitral flow velocity to annular velocity) have&#xD;
        been identified as PIH-independent risk factors.&#xD;
  &#xD;
        End-systolic elastance (Ees) is a measure of the contractile state of the left ventricle&#xD;
        (LV). It represents the relationship between LV end-systolic pressure (LVESP) and&#xD;
        end-systolic volume (ESV). Effective arterial elastance (Ea) is a measure of the total&#xD;
        arterial load on the LV and is calculated as the ratio of LVESP to stroke volume (SV).&#xD;
        Ventricular-arterial coupling (VAC), assessed by the ratio Ea/Ees, describes the interaction&#xD;
        between the LV and arterial system. VAC reflects the interplay between the changes in LV&#xD;
        contractility (Ees) and changes in arterial load (Ea) to maintain optimal LV performance.&#xD;
  &#xD;
        Aktas et al. analyzed Ea as a predictor of PIH. The results of this study showed that&#xD;
        pre-induction Ea had excellent predictability of hypotension. However, Ees values were not&#xD;
        determined, thus making it speculative to conclude that pre-induction VAC is impaired in&#xD;
        patients with high Ea. There are no studies available that assessed the role of preoperative&#xD;
        VAC in predicting PIH. Therefore, we will investigate the relationship between the&#xD;
        preoperative Ea/Ees ratio and the incidence of PIH (: hypotension being defined as MAP &lt; 65&#xD;
        mmHg).&#xD;
      </textblock>
    </detailed_description>
    <overall_status>Recruiting</overall_status>
    <start_date type="Actual">July 3, 2023</start_date>
    <completion_date type="Anticipated">July 2024</completion_date>
    <primary_completion_date type="Anticipated">July 2024</primary_completion_date>
    <study_type>Observational</study_type>
    <has_expanded_access>No</has_expanded_access>
    <study_design_info>
      <observational_model>Cohort</observational_model>
      <time_perspective>Prospective</time_perspective>
    </study_design_info>
    <primary_outcome>
      <measure>Prediction</measure>
      <time_frame>from induction of anesthesia to incision initiation</time_frame>
      <description>Investigate the predictive value of the Ea/Ees ratio (along with echocardiographic variables) on PIH.</description>
    </primary_outcome>
    <secondary_outcome>
      <measure>Incidence</measure>
      <time_frame>from induction of anesthesia to incision initiation</time_frame>
      <description>Determine the frequency of PIH</description>
    </secondary_outcome>
    <enrollment type="Anticipated">335</enrollment>
    <condition>Hypotension on Induction</condition>
    <eligibility>
      <study_pop>
        <textblock>
          Patients with American Society of Anesthesiologists (ASA) physical status 1 - 4 who&#xD;
          underwent elective surgery&#xD;
        </textblock>
      </study_pop>
      <sampling_method>Probability Sample</sampling_method>
      <criteria>
        <textblock>
          Inclusion Criteria:&#xD;
  &#xD;
            -  Patients ≥ 18 years old.&#xD;
  &#xD;
            -  Patients with ASA (American Society of Anesthesiologists) physical status 1 - 4.&#xD;
  &#xD;
            -  Elective surgery.&#xD;
  &#xD;
            -  Preoperative transthoracic echocardiography was performed within 48 hours before&#xD;
               surgery. The values of Ees and Ea were determined by the method of Chen.&#xD;
  &#xD;
            -  Patients consented to participate in the study.&#xD;
  &#xD;
            -  Patients scheduled for surgery undergoing standard general anesthesia (protocol: see&#xD;
               below) with endotracheal intubation.&#xD;
  &#xD;
            -  Patients were hemodynamically stable until the preoperative period.&#xD;
  &#xD;
          Exclusion Criteria:&#xD;
  &#xD;
            -  Cardiac and obstetric surgery.&#xD;
  &#xD;
            -  Allergy to any anesthetic drug.&#xD;
  &#xD;
            -  Arrhythmia.&#xD;
  &#xD;
            -  Severe valvular heart disease.&#xD;
  &#xD;
            -  Severe pre-existing lung disease.&#xD;
  &#xD;
            -  Mean pulmonary arterial pressure (PAPm ≥ 40 mmHg).&#xD;
  &#xD;
            -  Anticipation of difficult airway management.&#xD;
  &#xD;
            -  Hypotension occurs during the induction of anesthesia due to suspected anaphylaxis.&#xD;
        </textblock>
      </criteria>
      <gender>All</gender>
      <minimum_age>18 Years</minimum_age>
      <maximum_age>N/A</maximum_age>
      <healthy_volunteers>No</healthy_volunteers>
    </eligibility>
    <overall_official>
      <last_name>Khoi M Le, Assoc.Prof</last_name>
      <role>Study Director</role>
      <affiliation>University Medical Center</affiliation>
    </overall_official>
    <overall_contact>
      <last_name>Khoi M Le, MD PhD Prof</last_name>
      <phone>+84919731386</phone>
      <email>khoi.lm@umc.edu.vn</email>
    </overall_contact>
    <overall_contact_backup>
      <last_name>Vu TN Phan, MD, PhD</last_name>
      <phone>+84908883458</phone>
      <email>vu.ptn@umc.edu.vn</email>
    </overall_contact_backup>
    <location>
      <facility>
        <name>University Medical Centre Ho Chi Minh</name>
        <address>
          <city>Ho Chi Minh City</city>
          <country>Vietnam</country>
        </address>
      </facility>
      <status>Recruiting</status>
      <contact>
        <last_name>Chinh H Le, MD MSc</last_name>
        <phone>+84914425698</phone>
        <email>chinh.lh@umc.edu.vn</email>
      </contact>
      <investigator>
        <last_name>Chinh H Le, MD MSc</last_name>
        <role>Principal Investigator</role>
      </investigator>
      <investigator>
        <last_name>Khoi M Le, MD PhD Prof</last_name>
        <role>Principal Investigator</role>
      </investigator>
      <investigator>
        <last_name>Vu TN Phan, MD PhD</last_name>
        <role>Sub-Investigator</role>
      </investigator>
    </location>
    <location_countries>
      <country>Vietnam</country>
    </location_countries>
    <results_reference>
      <citation>Yoshimura M, Shiramoto H, Koga M, Morimoto Y. Preoperative echocardiography predictive analytics for postinduction hypotension prediction. PLoS One. 2022 Nov 28;17(11):e0278140. doi: 10.1371/journal.pone.0278140. eCollection 2022.</citation>
      <PMID>36441797</PMID>
    </results_reference>
    <results_reference>
      <citation>Maheshwari K, Turan A, Mao G, Yang D, Niazi AK, Agarwal D, Sessler DI, Kurz A. The association of hypotension during non-cardiac surgery, before and after skin incision, with postoperative acute kidney injury: a retrospective cohort analysis. Anaesthesia. 2018 Oct;73(10):1223-1228. doi: 10.1111/anae.14416. Epub 2018 Aug 24.</citation>
      <PMID>30144029</PMID>
    </results_reference>
    <results_reference>
      <citation>Sudfeld S, Brechnitz S, Wagner JY, Reese PC, Pinnschmidt HO, Reuter DA, Saugel B. Post-induction hypotension and early intraoperative hypotension associated with general anaesthesia. Br J Anaesth. 2017 Jul 1;119(1):57-64. doi: 10.1093/bja/aex127.</citation>
      <PMID>28974066</PMID>
    </results_reference>
    <results_reference>
      <citation>Chen B, Pang QY, An R, Liu HL. A systematic review of risk factors for postinduction hypotension in surgical patients undergoing general anesthesia. Eur Rev Med Pharmacol Sci. 2021 Nov;25(22):7044-7050. doi: 10.26355/eurrev_202111_27255.</citation>
      <PMID>34859868</PMID>
    </results_reference>
    <results_reference>
      <citation>Tarao K, Daimon M, Son K, Nakanishi K, Nakao T, Suwazono Y, Isono S. Risk factors including preoperative echocardiographic parameters for post-induction hypotension in general anesthesia. J Cardiol. 2021 Sep;78(3):230-236. doi: 10.1016/j.jjcc.2021.03.010. Epub 2021 Apr 8.</citation>
      <PMID>33838982</PMID>
    </results_reference>
    <results_reference>
      <citation>Monge Garcia MI, Santos A. Understanding ventriculo-arterial coupling. Ann Transl Med. 2020 Jun;8(12):795. doi: 10.21037/atm.2020.04.10.</citation>
      <PMID>32647720</PMID>
    </results_reference>
    <results_reference>
      <citation>Guinot PG, Andrei S, Longrois D. Ventriculo-arterial coupling: from physiological concept to clinical application in peri-operative care and ICUs. European Journal of Anaesthesiology and Intensive Care. 2022;1(2):e004. doi:10.1097/EA9.0000000000000004</citation>
    </results_reference>
    <results_reference>
      <citation>Aktas Yildirim S, Sarikaya ZT, Dogan L, Ulugol H, Gucyetmez B, Toraman F. Arterial Elastance: A Predictor of Hypotension Due to Anesthesia Induction. J Clin Med. 2023 Apr 27;12(9):3155. doi: 10.3390/jcm12093155.</citation>
      <PMID>37176595</PMID>
    </results_reference>
    <results_reference>
      <citation>Chen CH, Fetics B, Nevo E, Rochitte CE, Chiou KR, Ding PA, Kawaguchi M, Kass DA. Noninvasive single-beat determination of left ventricular end-systolic elastance in humans. J Am Coll Cardiol. 2001 Dec;38(7):2028-34. doi: 10.1016/s0735-1097(01)01651-5.</citation>
      <PMID>11738311</PMID>
    </results_reference>
    <results_reference>
      <citation>Mitchell C, Rahko PS, Blauwet LA, Canaday B, Finstuen JA, Foster MC, Horton K, Ogunyankin KO, Palma RA, Velazquez EJ. Guidelines for Performing a Comprehensive Transthoracic Echocardiographic Examination in Adults: Recommendations from the American Society of Echocardiography. J Am Soc Echocardiogr. 2019 Jan;32(1):1-64. doi: 10.1016/j.echo.2018.06.004. Epub 2018 Oct 1. No abstract available.</citation>
      <PMID>30282592</PMID>
    </results_reference>
    <results_reference>
      <citation>Cho JY, Kim KH. Evaluation of Arterial Stiffness by Echocardiography: Methodological Aspects. Chonnam Med J. 2016 May;52(2):101-6. doi: 10.4068/cmj.2016.52.2.101. Epub 2016 May 20.</citation>
      <PMID>27231673</PMID>
    </results_reference>
    <results_reference>
      <citation>Liu N, Chazot T, Genty A, Landais A, Restoux A, McGee K, Laloe PA, Trillat B, Barvais L, Fischler M. Titration of propofol for anesthetic induction and maintenance guided by the bispectral index: closed-loop versus manual control: a prospective, randomized, multicenter study. Anesthesiology. 2006 Apr;104(4):686-95. doi: 10.1097/00000542-200604000-00012.</citation>
      <PMID>16571963</PMID>
    </results_reference>
    <results_reference>
      <citation>Avidan MS, Zhang L, Burnside BA, Finkel KJ, Searleman AC, Selvidge JA, Saager L, Turner MS, Rao S, Bottros M, Hantler C, Jacobsohn E, Evers AS. Anesthesia awareness and the bispectral index. N Engl J Med. 2008 Mar 13;358(11):1097-108. doi: 10.1056/NEJMoa0707361.</citation>
      <PMID>18337600</PMID>
    </results_reference>
    <verification_date>July 2023</verification_date>
    <study_first_submitted>July 24, 2023</study_first_submitted>
    <study_first_submitted_qc>July 24, 2023</study_first_submitted_qc>
    <study_first_posted type="Actual">August 1, 2023</study_first_posted>
    <last_update_submitted>August 1, 2023</last_update_submitted>
    <last_update_submitted_qc>August 1, 2023</last_update_submitted_qc>
    <last_update_posted type="Actual">August 3, 2023</last_update_posted>
    <responsible_party>
      <responsible_party_type>Sponsor</responsible_party_type>
    </responsible_party>
    <keyword>Ventricular-Arterial Coupling (VAC)</keyword>
    <keyword>Ea/Ees ratio</keyword>
    <keyword>Post-induction hypotension (PIH)</keyword>
    <keyword>Risk factors for PIH</keyword>
    <condition_browse>
      <!-- CAUTION:  The following MeSH terms are assigned with an imperfect algorithm            -->
      <mesh_term>Hypotension</mesh_term>
    </condition_browse>
    <patient_data>
      <sharing_ipd>No</sharing_ipd>
    </patient_data>
    <!-- Results have not yet been posted for this study                                          -->
  </clinical_study>
  
  
text: download date: ClinicalTrials.gov processed this data on September 20, 2023
  link text: Link to the current ClinicalTrials.gov record.
  url: https://clinicaltrials.gov/ct2/show/NCT05969886
  org study id: 32/GCN-HDDD
  secondary id: No: 32/GCN-HDDD
  nct id: NCT05969886
  lead sponsor: 
  is fda regulated drug: No
  is fda regulated device: No
  Post-induction hypotension (PIH) is a common occurrence during the period from induction of
        general anesthesia to initiation of incision. PIH has been identified as an independent risk
        factor for postoperative major complications. Identifying high-risk patients for PIH could
        potentially help prevent its occurrence. Several risk factors associated with PIH have been
        identified, including patient conditions and use of specific anesthetic agents.
        Ventricular-arterial coupling (VAC) is evaluated using the ratio Ea/Ees and represents the
        interaction between the left ventricle (LV) and the arterial system. It reflects how changes
        in LV contractility (Ees) and changes in arterial load (Ea) work together to maintain optimal
        LV performance. A study aims to investigate the relationship between preoperative Ea/Ees
        ratio and the incidence of PIH (defined as MAP < 65 mmHg).
  Post-induction hypotension (PIH) is a common event due to general anesthesia in patients
        undergoing surgery. It is described as hypotension occurring during the period from induction
        of general anesthesia to initiation of incision. A universal definition of intraoperative
        hypotension is lacking, leading to inconsistent rates of occurrence for PIH. According to
        Yoshimura et al., PIH occurs in 34% of patients using the mean arterial pressure (MAP)
        definition of < 55 mmHg, whereas Maheshwari found PIH in 53% of patients using a MAP
        definition of < 65 mmHg. Furthermore, Maheshwari et al. demonstrated that PIH was an
        independent risk factor for postoperative major complications such as myocardial injury,
        cerebrovascular events, and acute kidney injury.
  
        If high-risk patients for PIH could be identified we might potentially prevent PIH. In a
        systematic review, Chen et al. pointed out that the risk factors associated with PIH were ASA
        (American Society of Anesthesiologists) III-V, advanced age, emergency cases, hypovolaemia,
        long-term use of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers,
        use of propofol and high-dose of opioid. This study suggests that PIH may be the result of an
        interaction between the anesthetic agent and the cardiovascular condition of the patient.
        Conditions such as moderate-to-severe aortic regurgitation, moderate-to-severe mitral
        regurgitation, regional wall motion abnormalities, and echocardiography findings (e.g.
        elevated ratio of peak early diastolic transmitral flow velocity to annular velocity) have
        been identified as PIH-independent risk factors.
  
        End-systolic elastance (Ees) is a measure of the contractile state of the left ventricle
        (LV). It represents the relationship between LV end-systolic pressure (LVESP) and
        end-systolic volume (ESV). Effective arterial elastance (Ea) is a measure of the total
        arterial load on the LV and is calculated as the ratio of LVESP to stroke volume (SV).
        Ventricular-arterial coupling (VAC), assessed by the ratio Ea/Ees, describes the interaction
        between the LV and arterial system. VAC reflects the interplay between the changes in LV
        contractility (Ees) and changes in arterial load (Ea) to maintain optimal LV performance.
  
        Aktas et al. analyzed Ea as a predictor of PIH. The results of this study showed that
        pre-induction Ea had excellent predictability of hypotension. However, Ees values were not
        determined, thus making it speculative to conclude that pre-induction VAC is impaired in
        patients with high Ea. There are no studies available that assessed the role of preoperative
        VAC in predicting PIH. Therefore, we will investigate the relationship between the
        preoperative Ea/Ees ratio and the incidence of PIH (: hypotension being defined as MAP < 65
        mmHg).
  observational model: Cohort
  time perspective: Prospective
  measure: Prediction
  time frame: from induction of anesthesia to incision initiation
  description: Investigate the predictive value of the Ea/Ees ratio (along with echocardiographic variables) on PIH.
  measure: Incidence
  time frame: from induction of anesthesia to incision initiation
  description: Determine the frequency of PIH
  study pop: 
  sampling method: Probability Sample
  criteria: 
  gender: All
  minimum age: 18 Years
  maximum age: N/A
  healthy volunteers: No
  last name: Khoi M Le, Assoc.Prof
  role: Study Director
  affiliation: University Medical Center
  last name: Khoi M Le, MD PhD Prof
  phone: +84919731386
  email: khoi.lm@umc.edu.vn
  last name: Vu TN Phan, MD, PhD
  phone: +84908883458
  email: vu.ptn@umc.edu.vn
  facility: 
  status: Recruiting
  contact: 
  investigator: 
  investigator: 
  investigator: 
  country: Vietnam
  citation: Yoshimura M, Shiramoto H, Koga M, Morimoto Y. Preoperative echocardiography predictive analytics for postinduction hypotension prediction. PLoS One. 2022 Nov 28;17(11):e0278140. doi: 10.1371/journal.pone.0278140. eCollection 2022.
  PMID: 36441797
  citation: Maheshwari K, Turan A, Mao G, Yang D, Niazi AK, Agarwal D, Sessler DI, Kurz A. The association of hypotension during non-cardiac surgery, before and after skin incision, with postoperative acute kidney injury: a retrospective cohort analysis. Anaesthesia. 2018 Oct;73(10):1223-1228. doi: 10.1111/anae.14416. Epub 2018 Aug 24.
  PMID: 30144029
  citation: Sudfeld S, Brechnitz S, Wagner JY, Reese PC, Pinnschmidt HO, Reuter DA, Saugel B. Post-induction hypotension and early intraoperative hypotension associated with general anaesthesia. Br J Anaesth. 2017 Jul 1;119(1):57-64. doi: 10.1093/bja/aex127.
  PMID: 28974066
  citation: Chen B, Pang QY, An R, Liu HL. A systematic review of risk factors for postinduction hypotension in surgical patients undergoing general anesthesia. Eur Rev Med Pharmacol Sci. 2021 Nov;25(22):7044-7050. doi: 10.26355/eurrev_202111_27255.
  PMID: 34859868
  citation: Tarao K, Daimon M, Son K, Nakanishi K, Nakao T, Suwazono Y, Isono S. Risk factors including preoperative echocardiographic parameters for post-induction hypotension in general anesthesia. J Cardiol. 2021 Sep;78(3):230-236. doi: 10.1016/j.jjcc.2021.03.010. Epub 2021 Apr 8.
  PMID: 33838982
  citation: Monge Garcia MI, Santos A. Understanding ventriculo-arterial coupling. Ann Transl Med. 2020 Jun;8(12):795. doi: 10.21037/atm.2020.04.10.
  PMID: 32647720
  citation: Guinot PG, Andrei S, Longrois D. Ventriculo-arterial coupling: from physiological concept to clinical application in peri-operative care and ICUs. European Journal of Anaesthesiology and Intensive Care. 2022;1(2):e004. doi:10.1097/EA9.0000000000000004
  citation: Aktas Yildirim S, Sarikaya ZT, Dogan L, Ulugol H, Gucyetmez B, Toraman F. Arterial Elastance: A Predictor of Hypotension Due to Anesthesia Induction. J Clin Med. 2023 Apr 27;12(9):3155. doi: 10.3390/jcm12093155.
  PMID: 37176595
  citation: Chen CH, Fetics B, Nevo E, Rochitte CE, Chiou KR, Ding PA, Kawaguchi M, Kass DA. Noninvasive single-beat determination of left ventricular end-systolic elastance in humans. J Am Coll Cardiol. 2001 Dec;38(7):2028-34. doi: 10.1016/s0735-1097(01)01651-5.
  PMID: 11738311
  citation: Mitchell C, Rahko PS, Blauwet LA, Canaday B, Finstuen JA, Foster MC, Horton K, Ogunyankin KO, Palma RA, Velazquez EJ. Guidelines for Performing a Comprehensive Transthoracic Echocardiographic Examination in Adults: Recommendations from the American Society of Echocardiography. J Am Soc Echocardiogr. 2019 Jan;32(1):1-64. doi: 10.1016/j.echo.2018.06.004. Epub 2018 Oct 1. No abstract available.
  PMID: 30282592
  citation: Cho JY, Kim KH. Evaluation of Arterial Stiffness by Echocardiography: Methodological Aspects. Chonnam Med J. 2016 May;52(2):101-6. doi: 10.4068/cmj.2016.52.2.101. Epub 2016 May 20.
  PMID: 27231673
  citation: Liu N, Chazot T, Genty A, Landais A, Restoux A, McGee K, Laloe PA, Trillat B, Barvais L, Fischler M. Titration of propofol for anesthetic induction and maintenance guided by the bispectral index: closed-loop versus manual control: a prospective, randomized, multicenter study. Anesthesiology. 2006 Apr;104(4):686-95. doi: 10.1097/00000542-200604000-00012.
  PMID: 16571963
  citation: Avidan MS, Zhang L, Burnside BA, Finkel KJ, Searleman AC, Selvidge JA, Saager L, Turner MS, Rao S, Bottros M, Hantler C, Jacobsohn E, Evers AS. Anesthesia awareness and the bispectral index. N Engl J Med. 2008 Mar 13;358(11):1097-108. doi: 10.1056/NEJMoa0707361.
  PMID: 18337600
  responsible party type: Sponsor
  mesh term: Hypotension
  sharing ipd: No