Feasibility of Anesthesiologist-Performed Preoperative Echocardiography for the Prediction of Postinduction Hypotension: A Prospective Observational Study

Abstract

Purpose. To determine if left ventricular or inferior vena cava (IVC) measurements are easier to obtain on point-of-care ultrasound by anesthesiologists in preoperative patients, and to assess the relationship between preoperative cardiac dimensions and hypotension with the induction of general anesthesia. Methods. This prospective observational study was conducted at a large academic medical center. Sixty-three patients undergoing noncardiac surgeries under general anesthesia were enrolled. Ultrasound examinations were performed by anesthesiologists in the preoperative area. To ensure that hypotension represented both a relative and absolute decrease in blood pressure, both a mean arterial pressure (MAP) < 65 mmHg and a MAP decrease of >30% from preoperative value defined this outcome. Results. Left ventricular measurements were more likely to be acquired than IVC measurements (97% vs. 79%). Subjects without adequate images to assess IVC collapsibility tended to have a higher body mass index (33.6 ± 5.5 vs. 28.5 ± 4.5, p = 0.001 ). While high left ventricular end-diastolic diameter values were associated with a decreased odds of MAP < 65 mmHg (OR: 0.24, 95% CI: 0.07–0.83, p = 0.023 ) or a MAP decrease of >30% from baseline alone (OR: 0.25, 95% CI: 0.07–0.83, p = 0.023 ), the primary endpoint of both relative and absolute hypotension was not associated with preoperative left ventricular dimensions. Conclusions. Preoperative cardiac ultrasound may be a more reliable way for anesthesiologists to assess patients’ volume status compared to ultrasound of the IVC, particularly for patients with a higher body mass index.

Preoperative echocardiography predictive analytics for postinduction hypotension prediction

“…Two studies have investigated the relationship between preoperative echocardiography and postinduction hypotension. Szabo et al reported the relationship between IVC and intraoperative hypotension [ 23 ], Fiza et al also conducted a prospective study on preoperative echocardiography and postinduction hypotension [ 24 ], but found no significant association between hypotension and IVC, left ventricular diastolic dimension. They found no significant association between IVC and left ventricular diastolic dimension, possibly due to the small sample size.…”

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

“…Incidence of PSH varied from 42.8% [13] to 76% [11] in pregnant patients undergoing caesarean section [11,13] and from 18.3% to 45% in nonpregnant patients [17,18,21]. Incidence of postinduction hypotension varied from 19.3% in the study by Mohammed et al [28] to 70% in the study by Fiza et al [30].…”

“…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.…”

Preoperative Ultrasound-based Protocol for Optimisation of Fluid Therapy to Prevent Early Intraoperative Hypotension: A Randomised Controlled Study

“…Most protocols estimate patients' volume status, and many of them rely on the respiratory variations of the inferior vena cava for this purpose. Although the well-documented methods of preload assessment are less accurate estimates of the uid status or uid responsiveness when used on spontaneously breathing patients [9,10] than in the case of mechanical ventilation [11,12], several studies including our previous experiences identi ed their potential role prior to general anaesthesia [13][14][15][16]. Even though a recent study showed the superiority of variations of left ventricular out ow velocity-time integral (LVOT-VTI) in the prediction of intraoperative hypotension [13], the feasibility of the evaluation of IVC collapsibility index (further IVCCI) still makes it a potential choice to guide perioperative uid therapy.…”