Inferior vena cava ultrasonography before general anesthesia cannot predict arterial hypotension in patients undergoing vascular surgery

Turconi, L.; Cavalleri, Fiorella; Moreno, L.G.; Surbano, Marta; Illescas, Laura; Bouchacourt, Juan Pablo; Kohn, Eduardo; Ferrari, Gaetano M. De; Riva, Juan

doi:10.1016/j.redare.2021.03.013

Cited by 4 publications

(7 citation statements)

References 20 publications

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“…IVC-CI had very poor predictive performance in hypertensive patients in the current study. Such a finding is consistent with previous studies ( 6 ) and highlights the need for an alternative measure to predict PIH. The following reasons may explain this result.…”

Section: Discussionsupporting

confidence: 92%

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Maximum inferior vena cava diameter predicts post-induction hypotension in hypertensive patients undergoing non-cardiac surgery under general anesthesia: A prospective cohort study

Zhang

Gao²,

Xiang³

et al. 2022

Front. Cardiovasc. Med.

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BackgroundInferior vena cava (IVC) ultrasonography is a reliable variable that predicts post-induction hypotension (PIH) in patients undergoing surgery under general anesthesia. However, in patients with hypertension, the predictive performance of ultrasound IVC measurements needs further exploration.MethodsThis is a prospective cohort study. Adult patients with existing hypertension scheduled to undergo non-cardiac surgery under general anesthesia were eligible. An abdominal ultrasound examination was conducted immediately prior to anesthesia induction (0.03 mg kg–1 midazolam, 0.3 mg kg–1 etomidate, 0.4 μg kg–1 sufentanil, and 0.6 mg kg–1 rocuronium). IVC collapsibility index (IVC-CI) was calculated as (dIVCmax–dIVCmin)/dIVCmax, where dIVCmax and dIVCmin represent the maximum and minimum IVC diameters at the end of expiration and inspiration, respectively. PIH was defined as a reduction of mean arterial pressure (MAP) by >30% of the baseline or to <60 mmHg within 10 min after endotracheal intubation. The diagnostic performance of IVC-CI, dIVCmax, and dIVCmin in predicting PIH was also examined in a group of normotensive patients receiving non-cardiac surgery under the same anesthesia protocol.ResultsA total of 51 hypertensive patients (61 ± 13 years of age, 31 women) and 52 normotensive patients (42 ± 13 years of age, 35 women) were included in the final analysis. PIH occurred in 33 (64.7%) hypertensive patients and 19 (36.5%) normotensive patients. In normotensive patients, the area under the receiver operating curve (AUC) in predicting PIH was 0.896 (95% confidence interval [CI]: 0.804–0.987) for IVC-CI, 0.770 (95% CI: 0.633–0.908) for dIVCmax, and 0.868 (95% CI: 0.773–0.963) for dIVCmin. In hypertensive patients, the AUC in predicting PIH was 0.523 (95% CI: 0.354–0.691) for IVC-CI, 0.752 (95% CI: 0.621–0.883) for dIVCmax, and 0.715 (95% CI: 0.571–0.858) for dIVCmin. At the optimal cutoff (1.24 cm), dIVCmax had 54.5% (18/33) sensitivity and 94.4% (17/18) specificity.ConclusionIn hypertensive patients, IVC-CI is unsuitable for predicting PIH, and dIVCmax is an alternative measure with promising performance.Clinical trial registration[http://www.chictr.org.cn/], identifier [ChiCTR2000034853].

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Section: Discussionsupporting

confidence: 92%

“…The predictive performance of ultrasound measurements of IVC (including IVC-CI and dIVC max ) is compromised in patients undergoing vascular surgery ( 6 ). This is particularly problematic since patients with hypertension are more likely to develop PIH than normotensive patients.…”

Section: Introductionmentioning

confidence: 99%

Maximum inferior vena cava diameter predicts post-induction hypotension in hypertensive patients undergoing non-cardiac surgery under general anesthesia: A prospective cohort study

Zhang

Gao²,

Xiang³

et al. 2022

Front. Cardiovasc. Med.

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“…Turconi et al . [ 8 ] investigated 55 high risk cardiac patients undergoing vascular surgery under GA and found IVCCI as a poor predictor of intraoperative hypotension. Aissaoui et al .…”

Section: Methodsmentioning

confidence: 99%

“…The study selection process for this review is depicted in Figure 1. Turconi et al [8] investigated 55 high risk cardiac patients undergoing vascular surgery under GA and found IVCCI as a poor predictor of intraoperative hypotension. Aissaoui et al [9] also found IVCCI > 42% as a poor predictor of hypotension after GA induction in 64 patients aged more than fifty years undergoing…”

Section: Study Selectionmentioning

confidence: 99%

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

Chowdhury¹,

Datta²,

Maitra³

et al. 2023

ait

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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-

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“…Ultrasound was used before induction to evaluate the volume status and predict PIH in an increasing number of studies [9][10][11]. However, the results are conflicting, given the various monitored parameters from ultrasound in different studies [12][13][14].…”

Section: Introductionmentioning

confidence: 99%

Preoperative Ultrasound for the Prediction of Postinduction Hypotension: A Systematic Review and Meta-Analysis

Liu,

An,

Liu

2024

JPM

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Postinduction hypotension (PIH) is closely associated with postoperative adverse outcomes. Preoperative hypovolemia is a key risk factor, and many parameters are available from ultrasound to detect hypovolemia, but the accuracy of PIH from ultrasound remains unclear. This systematic review and meta-analysis aimed to evaluate the commonly used measurements from ultrasound to predict PIH. We searched the PubMed, Cochrane Library, Embase, CNKI, and Web of Science databases from their inception to December 2023. Thirty-six studies were included for quantitative analysis. The pooled sensitivities for the inferior vena cava collapsibility index (IVC-CI), maximum inferior vena cava diameter (DIVCmax), minimum inferior vena cava diameter (DIVCmin), and carotid artery corrected flow time (FTc) were 0.73 (95% CI = 0.65, 0.79), 0.66 (95% CI = 0.54, 0.77), 0.74 (95% CI = 0.60, 0.85), and 0.81 (95% CI = 0.72, 0.88). The pooled specificities for the IVC-CI, DIVCmax, DIVCmin, and carotid artery FTc were 0.82 (95% CI = 0.75, 0.87), 0.75 (95% CI = 0.66, 0.82), 0.76 (95% CI = 0.65, 0.84), and 0.87 (95% CI = 0.77, 0.93). The AUC for the IVC-CI, DIVCmax, DIVCmin, and carotid artery FTc were 0.84 (95% CI = 0.81, 0.87), 0.77 (95% CI = 0.73, 0.81), 0.82 (95% CI = 0.78, 0.85), and 0.91 (95% CI = 0.88, 0.93). Our study demonstrated that ultrasound indices are reliable predictors for PIH. The carotid artery FTc is probably the optimal ultrasound measurement for identifying patients who will develop PIH in our study.

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Inferior vena cava ultrasonography before general anesthesia cannot predict arterial hypotension in patients undergoing vascular surgery

Cited by 4 publications

References 20 publications

Maximum inferior vena cava diameter predicts post-induction hypotension in hypertensive patients undergoing non-cardiac surgery under general anesthesia: A prospective cohort study

Maximum inferior vena cava diameter predicts post-induction hypotension in hypertensive patients undergoing non-cardiac surgery under general anesthesia: A prospective cohort study

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

Preoperative Ultrasound for the Prediction of Postinduction Hypotension: A Systematic Review and Meta-Analysis

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