Does pre-induction lithotomy position prevent post-induction hypotension in geriatric hypertensive patients ?

Aim: Induction-induced hypotension in patients undergoing surgery under general anesthesia is quite common and is associated with increased postoperative morbidity. In our study, we aimed to investigate the effect of lithotomy position on hypotension due to induction of general anesthesia in geriatric hypertensive patients. Materials and Method: The study was conducted in a randomized prospective manner in a total of 60 patients aged 65 years and older, who were scheduled for surgery in the lithotomy position, were diagnosed with essential hypertension, were using the same antihypertensive drug for at least 6 months, were included in the ASA II-III risk class, and consented was obtained. The patients were divided into 2 groups as Supine position (Group S) and Lithotomy position (Group L), each consisting of 30 people, by computer-assisted randomization. After the patients were taken to the operating table, both groups were sedated with intravenous 0.05 mg/kg midazolam and 1 µg/kg fentanyl. General anesthesia was induced with 5-7mg/kg thiopental after sedation in the patients in the supine group and 90 seconds after being placed in the lithotomy position in the patients in the lithotomy group. Induction in both groups was done by the same team at a constant speed in 30 seconds. The hemodynamic parameters (SAB, DAB, MAP, HR, SpO2), basal values of the patients were recorded at 0 min, 1 min, 2 min, 3 min, 4 min, 5 min after sedation, after induction. Results: Between Group S and Group L; There was no statistically significant difference between age, gender, height, body weight, ASA score, duration of surgery and anesthesia, comorbidity (DM) (p>0.05). Hypotension was encountered in the first 5 minutes after anesthesia induction in 42 of our 60 patients (70%). While hypotension was observed in 25 patients (83.3%) in Group S, hypotension was observed in 17 patients (56.7%) in Group L, and a statistically significant difference was found between the two groups (p=0.049). There was a statistically significant difference between the median values of the amount of ephedrine use according to the groups (p=0.001). There was no statistically significant difference in the frequency of hypotension between those using ACEI and/or ARB and those using other antihypertensive agents (beta blocker, diuretic, CCB, alpha blocker) in Group S and Group L (p>0.05). Conclusion: It was thought that applying induction in the lithotomy position in geriatric hypertensive patients scheduled for operation in the lithotomy position may be effective in preventing hypotension that may occur due to induction. It has also been observed that anesthesia induction in the lithotomy position reduces the need for ephedrine. Keywords: Geriatric Anesthesia, Lithotomy Position, Post-Induction Hypotension, Hypertension