Multiple Case Study: Overview of Hemodynamic Changes in Controlled Hypertensive Patients Undergoing Propofol Administration with Endotracheal Tube (ETT) General Anesthesia at Wangaya Regional General Hospital
Keywords:
controlled hypertension, endotracheal tube, general anesthesia, hemodynamics, propofolAbstract
Background: Controlled hypertensive patients undergoing surgical procedures under general anaesthesia are at risk of hemodynamic instability. Propofol, as an induction agent, causes cardiovascular depression through vasodilation, reduced sympathetic vasoconstrictive activity, and negative inotropic effects, resulting in fluctuations in blood pressure, mean arterial pressure (MAP), heart rate, respiratory rate (RR), and oxygen saturation ( ). Objective: To describe hemodynamic changes in controlled hypertensive patients receiving propofol induction during general anaesthesia with endotracheal tube (ETT) intubation at Wangaya Regional General Hospital. Methods: This study employed a qualitative descriptive design with a multiple case study approach involving five controlled hypertensive patients selected through purposive sampling. Data were collected via hemodynamic observation sheets at baseline (pre-induction) and at minutes 1, 3, 5, and 10 post-induction, semi-structured interviews, and medical record documentation. Data were analysed using single-case and cross-case analysis models. Results: All participants experienced consistent decreases in systolic blood pressure (SBP), diastolic blood pressure (DBP), MAP, and pulse rate from minute 1 to minute 10 following propofol induction. Participants receiving higher propofol doses (200 mg) demonstrated the greatest declines, reaching clinically significant drops ( ) in SBP and DBP, as well as near-significant drops ( ) in MAP and pulse rate. RR remained stable at 14 breaths/min and remained optimal ( ) due to mechanical ventilation and preoxygenation. Conclusion: Propofol induction in controlled hypertensive patients leads to a progressive decline in blood pressure, MAP, and pulse rate over the 10-minute post-induction period, with risk factor. Vigilant hemodynamic monitoring, particularly within the first 10 minutes post-induction, is essential to maintain stability and ensure patient safety
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Aggarwal, S., Goyal, V. K., Chaturvedi, S. K., Mathur, V., Baj, B., & Kumar, A. (2016). A comparative study between propofol and etomidate in patients under general anesthesia. Brazilian Journal of Anesthesiology (English Edition), 66(3), 237–241. https://doi.org/10.1016/j.bjane.2014.10.005
Alappat, A. M., Lagoo, J. Y., & Shivappagoudar, V. (2020). Evaluation of haemodynamic stability following induction of general anesthesia with propofol and etomidate in normotensive and hypertensive patients: A comparative study. GJRA: Global Journal For Research Analysis, 9(10). https://doi.org/DOI:10.36106/gjra
American Society of Anesthesiology. (2019). Statement on continuum of depth of sedation: definition of general anesthesia and levels of sedation/analgesia. https://www.asahq.org/standards-and-practice-parameters/statement-on-continuum-of-depth-of-sedation-definition-of-general-anesthesia-and-levels-of-sedation-analgesia
Bhat, S. D., Dalvi, N., & Thakur, M. D. (2020). A prospective randomized double-blind comparative study of hemodynamic effects of etomidate and propofol in controlled hypertensive patients during induction of general anesthesia. Archives of Anesthesiology and Critical Care, 8(1), 11–17. https://doi.org/10.18502/aacc.v8i1.8238
Bradshaw, C., Atkinson, S., & Doody, O. (2017). Employing a qualitative description approach in health care research. Global Qualitative Nursing Research, 4, 1–8. https://doi.org/10.1177/2333393617742282
Butterworth, J. F., Mackey, D. C., & Wasnick, J. D. (2018). Morgan & Mikhail’s clinical anesthesiology (6th ed.). McGraw-Hill Education.
Harrison, D. G., Coffman, T. M., & Wilcox, C. S. (2021). Pathophysiology of hypertension: The mosaic theory and beyond. Circulation Research, 128(7), 847–863. https://doi.org/10.1161/CIRCRESAHA.121.318082
Iorga, A., Cunningham, C. M., Moazeni, S., Ruffenach, G., Umar, S., & Eghbali, M. (2024). The protective role of estrogen and estrogen receptors in cardiovascular disease and the controversial use of estrogen therapy. Biology of Sex Differences, 8(1), 33. https://doi.org/10.1186/s13293-017-0152-8
Ismail, E. A., Mostafa, A. A., & Abdelatif, M. M. (2022). Attenuation of hemodynamic response to laryngoscopy and endotracheal intubation with single dose dexmedetomidine in controlled hypertensive patients: Prospective randomized double-blind study. Ain-Shams Journal of Anesthesiology, 14(1), 57. https://doi.org/10.1186/s42077-022-00255-w
Kawasaki, S., Kiyohara, C., Tokunaga, S., & Hoka, S. (2018). Prediction of hemodynamic fluctuations after induction of general anesthesia using propofol in non-cardiac surgery: A retrospective cohort study. Journal of Anesthesia, 32(5), 668–676. https://doi.org/10.1007/s00540-018-2536-6
Khan, N., Trumboo, O. N., & Qadri, A. B. (2024). Perioperative hemodynamic parameters in optimized hypertensive patients posted for elective surgical procedures under general anesthesia. Journal of Population Therapeutics and Clinical Pharmacology, 31(3). https://doi.org/10.53555/jptcp.v31i3.5038
Lestari, I., & Hustrini, N. M. (2020). Hipertensi. Dalam Kapita selekta kedokteran (5th ed., pp. 262–269). Media Aesculapius.
Lewar, E. I., Yusniawati, Y. N. P., Maharywan, I. W. A., Putra, I. G. A. S., & Djami, R. V. A. (2025). Pemberian penyuluhan kesehatan sebagai upaya pengendalian hipertensi kepada keluarga pasien yang akan dilakukan anestesi. JAI: Jurnal Abdimas ITEKES Bali, 5(1). https://doi.org/10.37294
Nagelhout, J. J., & Elisha, S. (2018). Nurse anesthesia (6th ed.). Elsevier.
Ni Luh Putu Lusiana Devi, I Ketut Setiabudi, & I Gusti Agung Tresna Wicaksana. (2023). Profil hemodinamik perianestesi pasien bedah oftamology dengan anestesi umum. Jurnal Keperawatan, 15(1), 1–10.
Purwono, J., Ma’ruf, A., Andalesti, F., & Yanti, A. H. (2020). Konsumsi garam dan kejadian hipertensi. Jurnal Ilmiah Ilmu-Ilmu Kesehatan, 18(1), 12–19.
Raja, P. J., & Surya, T. R. (2024). Farmakoterapi hipertensi. Jurnal Kesehatan, 17(1), 1–12.
Rahmantika, F. (2021). Hubungan antara kebiasaan merokok dengan kejadian hipertensi. Jurnal Ilmu Kesehatan Masyarakat, 10(1), 45–54.
Rehatta, N. M., Hanindito, E., Tantri, A. R., Redjeki, I. S., Soenarto, R. F., Harijanto, E., … & Lalisang, R. C. A. (2019). Anestesiologi dan terapi intensif: Buku teks kati-perdatin. PT. Gramedia Pustaka Utama.
Ridho, A., Maharani, C., Rahayu, D., Amalia, L., & Sartika, D. (2017). Stres dan kejadian hipertensi. Jurnal Kesehatan Masyarakat, 11(2), 121–128.
Simanjuntak, A. T., Soenarto, R., & Suryaminata, H. (2021). Perbandingan waktu induksi, perubahan tekanan darah dan pulih sadar antar total intravenous anesthesia propofol targets-controlled infusion dan manual controlled infusion. Jurnal Anestesi Perioperatif, 9(1), 41–49.
Sugiyono. (2022). Metode penelitian kualitatif. Alfabeta.
Unger, T., Borghi, C., Charchar, F., Khan, N. A., Poulter, N. R., Prabhakaran, D., … & Schutte, A. E. (2020). 2020 International Society of Hypertension global hypertension practice guidelines. Hypertension, 75(6), 1334–1357. https://doi.org/10.1161/HYPERTENSIONAHA.120.15026
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