Assessment of role of inferior vena cava collapsibility index and variations in carotid artery peak systolic velocity in prediction of post-spinal anaesthesia hypotension in spontaneously breathing patients: An observational study

Abstract

Background and Aims: Post-spinal anaesthesia hypotension (PSH) is common and can lead to significant morbidity and mortality. The inferior vena cava collapsibility index (IVCCI) and carotid artery peak systolic velocity variations (CAPVV) are two widely used parameters for assessing the volume status of critically ill patients which have also been investigated as predictors of PSH and hypotension after induction of general anaesthesia. In this study, we evaluated the diagnostic accuracy of IVCCI and CAPVV as predictors of PSH. Methods: A total of 50 patients aged between 18 and 65 years undergoing elective lower abdominal surgeries under spinal anaesthesia were included. The IVCCI and CAPVV were measured using ultrasound pre-operatively. After administering spinal anaesthesia, haemodynamic data were collected till 15 min. Our primary objective was to evaluate the role of IVCCI and CAPVV to predict PSH. The secondary objectives were to compare the predictive efficacy of these two parameters and to detect other parameters for predicting PSH. We constructed the receiver operator characteristic (ROC) curves for IVCCI and CAPVV and obtained the best cut-off values. Results: The PSH occurred in 34% of the patients. IVCCI >21.15 could predict PSH with 58.8% sensitivity and 69.7% specificity. CAPVV >18.33 predicted PSH with 70.6% sensitivity and 54.6% specificity and IVC max/IVCCI >60 could predict PSH with 58.8% sensitivity and 54.5% specificity. A composite model comprising IVCmax (maximum IVC diameter), CAPVV, and baseline mean blood pressure was able to predict PSH. Conclusion: Both IVCCI and CAPVV have poor diagnostic accuracy in predicting PSH in adult patients undergoing elective infra-umbilical surgery.

The use of preoperative inferior vena cava ultrasound to predict anaesthesia-induced hypotension: a systematic review

“…The definition of PSH varied widely among different studies: fall in SBP > 20% [ 11 , 13 ], fall in SBP > 25% [ 15 , 16 , 25 ], fall in SBP > 30% [ 20 ], absolute fall in SBP > 50 mmHg [ 25 ], SBP value < 90 mmHg [ 24 ], SBP < 80 mmHg [ 25 ], fall in MAP > 20% [ 12 , 14 , 18 ], fall in MAP > 30% [ 17 , 23 ], MAP < 65 mmHg [ 12 , 14 , 22 ], MAP < 60 mmHg [ 15 – 17 , 24 , 25 ], and fall in BP (unspecified) > 30% [ 19 , 21 ]. The timeframe for PSH was defined as within 15 minutes after spinal drug administration in 3 studies [ 12 , 18 , 20 ], within 30 minutes in 2 studies [ 19 , 23 ], within 45 minutes in one study [ 21 ], and until the end of surgery in two studies [ 11 , 22 ]. The rest of the studies did not clearly define any timeframe in the definition of PSH.…”

“…The role of IVCUS to predict PSH was assessed in 15 studies [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25]. Among them 4 prospective observational studies evaluated PSH in a parturient undergoing caesarean section [11][12][13][14].…”

“…In studies among non-parturients, 4 studies were randomized controlled trials [15][16][17]25] and the rest were observational studies [18][19][20][21][22][23][24]. These studies were conducted in procedures such as hernia and hydrocele [16], orthopaedic lower limb surgery [15,[20][21][22], and various other operations performed under spinal anaesthesia.…”

“…Two studies recruited only elderly patients [22,23]. Among the studies done in non-parturient patients, 8 studies excluded American Society of Anaesthesiology (ASA) class ≥ III [15][16][17][18][19][20][21]24], whereas 1 study each included ASA class I-III [25], ASA class II-III [22]and ASA class I-IV [23] Six observational studies evaluated the role of preoperative IVCUS for PIH in non-pregnant patients undergoing elective surgery under GA [26][27][28][29][30][31]. All these studies were done in adult patients.…”

“…The local anaesthetic drugs used for SA were both plain and hyperbaric bupivacaine, isobaric ropivacaine and levobupivacaine [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25]. The most common adjuvant drug for SA was fentanyl.…”