Preventing intraoperative hypotension in propofol-sedated gastroenteroscopy: a randomized trial of crystalloid preloading.

BACKGROUND

Intraoperative hypotension (IOH) is common during propofol-sedated gastroenteroscopy, yet preventive strategies in outpatient settings remain limited. We evaluated whether crystalloid preloading reduces IOH.

METHODS

In this prospective randomized clinical trial, 606 patients were assigned to receive crystalloid preloading (10 mL/kg lactated Ringer's over 25 min) or no preprocedural fluid. The primary outcome was the incidence of IOH. Secondary outcomes included Inferior Vena Cava Collapsibility Index (IVC-CI), vasopressor use, recovery time, and adverse events.

RESULTS

Six hundred and six participants were randomized into two groups, and 522 completed the trial per protocol. IOH occurred in 14.2% (43/303) of patients in the Preload group versus 25.4% (77/303) in the Control group (risk ratio = 0.56; 95% CI 0.40-0.78; P < 0.001), corresponding to an absolute risk reduction of 11.2% (number needed to treat=9). Preloading reduced ΔIVC-CI and ephedrine use (both P < 0.05). Propofol use, recovery time, procedure duration, and adverse events were similar between groups.

CONCLUSIONS

Crystalloid preloading reduces the incidence and severity of IOH during propofol-sedated gastroenteroscopy without increasing adverse events. This simple strategy may improve hemodynamic stability in outpatient anesthesia.