Exploring Hemodynamic Alterations: The Impact of Post-Induction and Pre-Intubation Urinary Catheterization in General Anesthesia: A Randomized Controlled Trial

Abstract

General anesthesia with endotracheal intubation is essential for major surgical procedures; however, the associated laryngoscopy and intubation elicit significant hemodynamic responses, posing risks particularly in susceptible patients. Although noxious stimuli are traditionally deferred until after securing the airway, modern anesthetic techniques and depth monitoring may allow for safe pre-intubation interventions that improve operating room efficiency. This study aimed to evaluate whether urinary catheterization, a minor but potentially painful procedure, performed after anesthetic induction and prior to intubation, induces significant hemodynamic alterations. In this prospective, single-blind, randomized controlled trial, 60 adult patients undergoing elective open abdominal surgery were randomly assigned to either an intervention group (catheterization after induction and before intubation) or a control group (no catheterization). Hemodynamic variables—systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), heart rate (HR)—and bispectral index (BIS) were recorded at five predefined time points: before induction, after induction, before and after catheterization, and post-intubation. No significant intergroup differences were observed in HR, DBP, MAP, or BIS at any time point except after intubation. Post-intubation, the control group demonstrated significantly higher SBP and MAP compared to the intervention group (SBP: 130.9±11.8 vs. 122.5±10.4 mmHg, P=0.027; MAP: 99.2±8.3 vs. 91.7±8.1 mmHg, P=0.032). BIS values remained within the target range (40-60) in both groups, indicating consistent anesthetic depth. Urinary catheterization performed after induction and before intubation does not cause significant hemodynamic instability or alter the depth of consciousness. This finding supports the safe incorporation of minor procedural steps prior to airway instrumentation, potentially enhancing intraoperative workflow without compromising patient safety. Validation in broader patient populations is warranted.