Intraoperative HypotensionPRO-JUGULARNCT07638306
Internal Jugular Vein Ultrasound and Acute Kidney Injury After Abdominal Surgery
An observational study of Intraoperative Hypotension and Jugular Veins, run by Tîrgu Mureș Emergency Clinical County Hospital, Romania at 1 site in Romania.
Trial summary
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. Read more about this study
- Who is it for?
- Ages 18 years and olderHealthy volunteers can take part
- Conditions the study is for
- Intraoperative Hypotension, Jugular Veins, Hypotension on Induction
- What is being tested?
- Internal Jugular Vein Ultrasound Assesment
- Type of treatment
- Surgery or procedure
- How many people
- 150 participants
- Where
- 1 siteRomania
- Study dates
- 7 Sep 2026to 28 Mar 2027
- How long will I take part?
- 1 Month
- Phase
- Observational
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 years and older
- All sexes
- Healthy volunteers accepted
- Adult, Older adult
Study population: 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.
Who may be able to join
- 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)
- Serum creatinine and eGFR (CKD-EPI) available within 30 days prior to surgery
- Written informed consent obtained before surgery
- Patient accessible by phone 30 days postoperatively
Who cannot join
- 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
- Known Internal Jugular Vein/ Inferior Vena Cava thrombosis or Superior Vena Cava syndrome
- Any anatomical neck abnormalities precluding Internal jugular vein ultrasound
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- Induction with ketamine or etomidate as sole Induction agent
- Neuraxial anesthesia (spinal or epidural) before propofol induction
- Active decompensated heart failure (NYHA IV or acute pulmonary edema at time of Surgery)
- Same-admission reoperation within 30-day study window
- Withdrawal of consent at any point
Trial locations and contacts
1 site in 1 country. Contact the study team or a site near you to ask about taking part.
Romania1 site, 1 recruiting
- Recruiting
County Emergency Clinical Hospital of Targu Mureș
Târgu Mureş, Mureș County, 540136
Matild Keresztes, MD, 0741784066, keresztesmatild@gmail.com
Janos Szederjesi, MD, PhD Assoc Prof, +40745316221, yangzi37@gmail.com
About this study
Official title: Dynamic Internal Jugular Vein Assessment During Anesthesia Induction as a Predictor of Hemodynamic Instability and Postoperative Outcomes
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:
- Can the internal jugular vein collapsibility index before anesthesia predict low blood pressure during induction?
- 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.
Read the detailed description
This is a single-centre prospective observational study of adults undergoing major abdominal or visceral surgery under general anesthesia. The study is designed to see whether bedside ultrasound measurements of the internal jugular vein can help identify participants who are at risk of low blood pressure during anesthesia induction and acute kidney injury after surgery.
Participants will have one ultrasound scan while awake before anesthesia and a second scan shortly after loss of consciousness following propofol induction. The researchers will calculate the internal jugular vein collapsibility index from both scans and determine the change between them. They will then compare these measurements with blood pressure changes during the induction period and with postoperative kidney function, which will be assessed using routine creatinine tests.
The study includes adults aged 18 years and older who are having elective or urgent non-emergency major abdominal or visceral surgery. Participants must receive propofol for anesthesia induction and must have blood pressure monitoring during surgery. People with emergency surgery, dependence on dialysis, major anatomic abnormalities that prevent ultrasound scanning of the neck, or other conditions that would invalidate the ultrasound measurement will not be included.
The study does not change routine anesthesia care. The ultrasound scans and blood tests are added only for research purposes, and the results are intended to help predict risk rather than guide treatment during the study itself.
- Conditions
- Intraoperative Hypotension, Jugular Veins, Hypotension on Induction, General Anesthesia With Propofol
- Being tested
- Internal Jugular Vein Ultrasound Assesment
- Keywords
- Post-induction Hypotension, Internal Jugular Vein, Collapsibility Index, Propofol Induction, Acute Kidney Injury
- Medical subject headings
- Acute Kidney Injury
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Internal Jugular Vein Ultrasound AssesmentProcedure or surgery
Point-of-care Internal jugular vein ultrasound performed before induction and immediately after propofol induction to measure vein diameter and collapsibility index.
| Study group | Role | What they receive |
|---|---|---|
| Propofol Peri-induction IJV cohort | Prospective observational cohort of adult patients undergoing elective or urgent non-emergent major abdominal or visceral surgery under general anesthesia with propofol induction. Participants will undergo pre-induction and immediate post-induction internal jugular vein ultrasound measurements to evaluate whether changes in internal jugular vein collapsibility predict post-induction hypotension and postoperative acute kidney injury. Receives: Procedure: Internal Jugular Vein Ultrasound Assesment |
What is being measured
The primary outcome is the main question the study is designed to answer.
Post-induction hypotension
Incidence of mean arterial pressure below 65 mmHg for atleast one consecutive minute during propofol induction
Measured: Periprocedural
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
Measured: From pre-induction to immediate post-induction
Secondary outcomes (2)
Postoperative Acute Kidney Injury
Acute Kidney Injury defined according to KDIGO criteria based on postoperative serum creatinine measurements
Measured: Postoperative days one to three
Cumulative Intra-operative Hypotension Burden
Total duration of mean arterial pressure threshold of 65 mmHg during the operative period
Measured: Induction to End of Surgery
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted10 Jun 2026
- Study start7 Sep 2026
- Primary completion31 Jan 2027 (estimated)
- Study completion28 Mar 2027 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (7)Papers the sponsor has linked to this study.
- Other trials for Intraoperative HypotensionStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Observational
- Observational model
- Cohort
- Time perspective
- Prospective
- Enrolment
- 150 participants (estimated)
- Target duration
- 1 Month
Sponsor and investigators
- Lead sponsor
- Tîrgu Mureș Emergency Clinical County Hospital, Romania
- Sponsor type
- University, hospital or other
- Responsible party
- Principal investigator, Matild Keresztes, Tîrgu Mureș Emergency Clinical County Hospital, Romania
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT07638306
- Sponsor's protocol ID
- 7979
- Acronym
- PRO-JUGULAR
- Status last verified
- Sep 2026
- First submitted
- 21 May 2026
- Last updated
- 10 Sep 2026
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- Undecided
Publications
Saugel B, Sander M, Kouz K, Habicher M. Association of intraoperative hypotension and cumulative norepinephrine dose with postoperative acute kidney injury in patients having noncardiac surgery. Response to Br J Anaesth 2025; 134: 1552-3. Br J Anaesth. 2025 Jul;135(1):247-248. doi: 10.1016/j.bja.2025.03.035. Epub 2025 May 10. No abstract available.
PubMed 40350350Salmasi V, Maheshwari K, Yang D, Mascha EJ, Singh A, Sessler DI, Kurz A. Relationship between Intraoperative Hypotension, Defined by Either Reduction from Baseline or Absolute Thresholds, and Acute Kidney and Myocardial Injury after Noncardiac Surgery: A Retrospective Cohort Analysis. Anesthesiology. 2017 Jan;126(1):47-65. doi: 10.1097/ALN.0000000000001432.
PubMed 27792044Liu J, Lin SH, Zhao YS, Luo RJ, Zhang ZT, Wang LY, Xie K, Fan J, Zhang M, Chai YS, Tang H, Xu F. Incidence and risk factors of acute kidney injury after abdominal surgery: a systematic review and meta-analysis. Ann Med. 2025 Dec;57(1):2547324. doi: 10.1080/07853890.2025.2547324. Epub 2025 Aug 17.
PubMed 40819346Okamura K, Nomura T, Mizuno Y, Miyashita T, Goto T. Pre-anesthetic ultrasonographic assessment of the internal jugular vein for prediction of hypotension during the induction of general anesthesia. J Anesth. 2019 Oct;33(5):612-619. doi: 10.1007/s00540-019-02675-9. Epub 2019 Aug 26.
PubMed 31451896Yildirim SA, Dogan L, Sarikaya ZT, Ulugol H, Gucyetmez B, Toraman F. Hypotension after Anesthesia Induction: Target-Controlled Infusion Versus Manual Anesthesia Induction of Propofol. J Clin Med. 2023 Aug 14;12(16):5280. doi: 10.3390/jcm12165280.
PubMed 37629322Sessler DI, Bloomstone JA, Aronson S, Berry C, Gan TJ, Kellum JA, Plumb J, Mythen MG, Grocott MPW, Edwards MR, Miller TE; Perioperative Quality Initiative-3 workgroup; POQI chairs; Miller TE, Mythen MG, Grocott MP, Edwards MR; Physiology group; Preoperative blood pressure group; Intraoperative blood pressure group; Postoperative blood pressure group. Perioperative Quality Initiative consensus statement on intraoperative blood pressure, risk and outcomes for elective surgery. Br J Anaesth. 2019 May;122(5):563-574. doi: 10.1016/j.bja.2019.01.013. Epub 2019 Feb 27.
PubMed 30916004Sun Z, Wang K, Ji P. Incidence and risk factors for perioperative hypotension during noncardiac surgery: A retrospective cohort study. Medicine (Baltimore). 2026 Jan 9;105(2):e46451. doi: 10.1097/MD.0000000000046451.
PubMed 41517769