Role of inferior vena cava collapsibility index in the prediction of hypotension associated with general anesthesia: an observational study (original) (raw)
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Research Square (Research Square), 2019
Background: Intraoperative hypotension increases 30-day mortality and the risks of myocardial injury and acute renal failure. Patients with inadequate volume reserve before the induction of anesthesia are highly exposed. The identi cation of latent hypovolemia is therefore crucial. Ultrasonographic measurement of the inferior vena cava collapsibility index (IVCCI) is able to detect volume responsiveness in circulatory shock. No current evidence is available regarding whether preoperative measurement of the IVCCI could identify patients at high risk for hypotension associated with general anesthesia. Methods: A total of 102 patients undergoing elective general surgery under general anesthesia with standardized propofol induction were recruited for this prospective observational study. The IVCCI was measured under spontaneous breathing. A collapsing (IVCCI≧50%) (CI+) and a noncollapsing (CI-) group were formed. Immediate postinduction changes in systolic and mean blood pressure were compared. The performance of the IVCCI as a diagnostic tool for predicting hypotension (systolic pressure <90 mmHg or a ≥30% drop from the baseline) was evaluated by ROC curve analysis. Results: A total of 83 patients were available for analysis, with 20 in the CI+ and 63 in the CI-group, we excluded 19 previously eligible patients due to inadequate visualization of the IVC (7 cases), lack of adherence to the protocol (8 cases), missing data (2 cases) or change in anesthesiologic management (2 cases). The mean decrease in systolic pressure in the CI+ group was 53.8±15.3 compared to 35.8±18.1 mmHg in CI-patients (P=0.0001). The relative mean arterial pressure change medians were 34.1% (IQR 23.2%-43.0%) and 24.2% (IQR 17.2%-30.2%), respectively (P=0.0029). The ROC curve analysis for IVCCI showed an AUC of 64.8% (95%CI 52.1-77.5%). The selected 50% level of the IVCCI had a sensitivity of only 45.5% (95%CI 28.1-63.7%), but the speci city was high at 90.0% (78.2-96.7%). The positive predictive value was 75.0% (95%CI 50.9-91.3%), and the negative predictive value was 71.4% (95%CI 58.7-82.1%). Conclusion: In spontaneously breathing preoperative noncardiac surgical patients, preoperatively detected IVCCI≧50% can predict postinduction hypotension with high speci city but low sensitivity. Despite moderate performance, IVCCI is an easy, noninvasive and attractive option to identify patients at risk and should be explored further.
Inferior Vena Cava Ultrasonography before General Anesthesia Can Predict Hypotension after Induction
Anesthesiology, 2016
Hypotension is a common side effect of general anesthesia induction, and when severe, it is related to adverse outcomes. Ultrasonography of inferior vena cava (IVC) is a reliable indicator of intravascular volume status. This study investigated whether preoperative ultrasound IVC measurements could predict hypotension after induction of anesthesia. One hundred four adult patients, conforming to American Society of Anesthesiologists physical status I to III, scheduled for elective surgery after general anesthesia were recruited. Maximum IVC diameter (dIVCmax) and collapsibility index (CI) were measured preoperatively. Before induction, mean blood pressure (MBP) was recorded. After induction, MBP was recorded for 10 min after intubation. Hypotension was defined as greater than 30% decrease in MBP from baseline or MBP less than 60 mmHg. Receiver operating characteristic curve analysis with gray zone approach and regression analyses were used. IVC scanning was unsuccessful in 13.5% of p...
Acta medica Lituanica
The study was performed at the Department of Orthopaedics and Traumatology of the Kauno Klinikos Hospital of Lithuanian University of Health Sciences. Background. Intravascular fluids are empirically administered to prevent hypotension induced by spinal anaesthesia. Ultrasound measurements of the inferior vena cava (IVC) and the IVC collapsibility index (IVC-CI) is a non-invasive method to evaluate the intravascular volume status. The aim of the study was to identify the prognostic value of the IVC collapsibility index in spontaneously breathing patients to predict severe intraoperative hypotension. Materials and methods. Sixty patients undergoing elective knee arthroplasty under spinal anaesthesia were included in the prospective study. The diameters of IVCex, IVCin, and IVC-CI were measured before and 15 min after spinal anaesthesia when administration of 500 ml of normal saline using infusion pump was finished. The haemodynamic parameters (heart rate, systolic, diastolic, and mea...
The Egyptian Journal of Hospital Medicine
Background: Maintaining the stability of hemodynamics is crucial for the reduction of the rate of postoperative complications. Hypotension during surgery has profound effect on the heart, which may lead to myocardial injury, and hypoperfusion of the kidneys. Therefore, predicting post-induction hypotension (PIH) is crucial to surgical patients. Objective: This study aimed to validate common femoral vein (CFV) diameter as a predictor for post-induction hypotension as compared to inferior vena cava (IVC) diameter. Patients and Methods: 90 non-cardiac patients undergoing surgery under general anesthesia were recruited for the study. The diameters of (IVC) and CFV were measured by ultrasonography prior to the surgery and post induction. Blood pressure was monitored at predetermined points of time: before anesthesia, at zero time, and at 2 min intervals after that. Results: In the current study, our results were consistent with the previously reported literature. The CFV diameter showed significant increase post induction compared to pre-induction. Such increase was concomitant with significant PIH in susceptible patients. Moreover, the changes observed in CFV diameter were synchronous with increase in IVC diameter in patients suffering from PIH. No significant changes were observed between age groups in either the IVC or CFV diameter. According to our observations, hypertensive patients suffered more PIH but the results were only significant regarding diastolic blood pressure. Conclusion: Our results showed comparable predictability of CFV diameter to IVC diameter ultrasonographic measurements in anticipating post-induction hypotension (PIH) in generally anesthetized patients. Therefore, the CFV offers a reliable alternative in cases where the IVC cannot be visualized or had limited accuracy. Variations in CFV and IVC diameters were insignificant in different age categories, which indicate the reliability of both vessels regardless of age group.
Anaesthesiology Intensive Therapy
Intraoperative hypotension after induction or initiation of anaesthesia is a common complication in clinical practice. It has been associated with poor patient outcomes including increased perioperative morbidity and even mortality [1]. Some special patient populations, such as the elderly and pregnant women undergoing caesarean section, are particularly prone to developing significant anaesthesia-induced hypotension (AIH) due to their unique physiological characteristics. Hypotension after induction of general anaesthesia (PIH, postinduction hypotension) or administration of spinal anaesthesia (PSH, post-spinal hypotension) is common and profound in patients with intravas
Predictors of Hypotension After Induction of General Anesthesia
Anesthesia and Analgesia, 2005
Hypotension after induction of general anesthesia is a common event. In the current investigation, we sought to identify the predictors of clinically significant hypotension after the induction of general anesthesia. Computerized anesthesia records of 4096 patients undergoing general anesthesia were queried for arterial blood pressure (BP), demographic information, preoperative drug history, and anesthetic induction regimen. The median BP was determined preinduction and for 0 -5 and 5-10 min postinduction of anesthesia. Hypotension was defined as either: mean arterial blood pressure (MAP) decrease of Ͼ40% and MAP Ͻ70 mm Hg or MAP Ͻ60 mm Hg. Overall, 9% of patients experienced severe hypotension 0 -10 min postinduction of general anesthesia. Hypotension was more prevalent in the second half of the 0 -10 min interval after anesthetic induction (P Ͻ 0.001). In 2406 patients with retrievable outcome data, prolonged postoperative stay and/or death was more common in patients with versus those without postinduction hypotension (13.3% and 8.6%, respectively, multivariate P Ͻ 0.02). Statistically significant multivariate predictors of hypotension 0 -10 min after anesthetic induction included: ASA III-V, baseline MAP Ͻ70 mm Hg, age Ն50 yr, the use of propofol for induction of anesthesia, and increasing induction dosage of fentanyl. Smaller doses of propofol, etomidate, and thiopental were not associated with less hypotension. To avoid severe hypotension, alternatives to propofol anesthetic induction (e.g., etomidate) should be considered in patients older than 50 yr of age with ASA physical status Ն3. We conclude that it is advisable to avoid propofol induction in patients who present with baseline MAP Ͻ70 mm Hg.
Incidence of Intraoperative Hypotension as a Function of the Chosen Definition
Anesthesiology, 2007
Background Intraoperative hypotension (IOH) is a common side effect of general anesthesia and has been reported to be associated with adverse perioperative outcomes. These associations were found using different definitions for IOH. It is unknown whether the incidences of IOH found with those different definitions are comparable. The authors aimed to describe the relation between the chosen definition and incidence of IOH. Methods First, a systematic literature search was performed to identify recent definitions of IOH that have been used in the anesthesia literature. Subsequently, these definitions were applied to a cohort of 15,509 consecutive adult patients undergoing noncardiac surgery during general anesthesia. The incidence of IOH according to the different threshold values was calculated, and the effect of a defined minimal duration of a hypotensive episode was studied. Results Many different definitions of IOH were found. When applied to a cohort of patients, these different...
The European Research Journal, 2021
Objectives: Hypotension is a common complication of spinal anesthesia. Imaging of inferior vena cava (IVC) and measurement of the IVC-collapsibility index (IVC-CI) by ultrasonography (USG) has been a widely used non-invasive, easy and reliable method for measurement of the fluid imbalance. In the present study, we aimed to investigate the predictive ability of the maximum IVC diameter (dIVCmax) and IVC-CI for hypotension after spinal anesthesia. Methods: The study was designed as prospective and observational. One hundred thirty-two patients aged 18-75 years with ASA I-II underwent inguinal hernia surgery with spinal anesthesia and recruited to the study. Maximum and minimum (dIVCmin) IVC diameters were measured. IVC-CI (%) was quantified according to the formula of [(dIVCmax-dIVCmin)/dIVKmax]×100%. Results: The patients were grouped as hypotensive and non-hypotensive. In fifty-seven patients of 120 cases (47.5%), hypotension has emerged following spinal anesthesia. No significant differences in dIVCmax and IVC-CI were recorded between the study groups (p > 0.05). There were significant inverse correlation between age and IVC-CI. Significant positive correlation between the lowest values of the systolic arterial pressure, diastolic arterial pressure, mean arterial pressure and IVC-CI and significant positive correlation between dIVCmax and diastolic blood pressure, maximum and minimum values of the mean arterial pressure. Conclusions: We found that dIVCmax and IVC-CI values measured before spinal anesthesia were not sufficient parameters enough to predict hypotension after spinal anesthesia. Further studies investigating the IVC measurements under spinal anesthesia together with dynamic hemodynamic monitorization modalities are needed.
Journal of Ultrasound in Medicine, 2019
ObjectivesHypotension is common after induction of general anesthesia, and intraoperative hypotension is associated with postoperative end‐organ injury such as acute kidney injury and myocardial ischemia. This study was designed to determine the utility of the carotid corrected flow time (cFT) and carotid artery peak blood flow velocity variation (ðVpeak) for prediction of hypotension after induction of general anesthesia.MethodsAdult patients (n = 112) undergoing any elective surgery under general anesthesia who fasted for at least 6 to 8 hours were recruited in this prospective observational study. The common carotid artery cFT and ðVpeak were measured with ultrasound 10 minutes before induction of general anesthesia. After that, general anesthesia with propofol was used, and hemodynamic data were collected until 3 minutes after induction of anesthesia.ResultsThe carotid cFT was significantly correlated with percentages of the fall in the systolic blood pressure at 2 minutes (P &l...