Prediction of post-induction hypotension by point-of-care echocardiography: A prospective observational study

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

“…study demonstrates that a combination of preoperative IVC and pulmonary ultrasound is a feasible way of guiding preprocedural uid therapy, and it is an effective way to decrease the incidence of early intraoperative hypotension. Of note, the occurrence rate of relative hypotension was relatively high, but the absolute MAP criterion was diagnosed in a rate which was comparable to the results of earlier studies in the CFT group, and we were able to decrease it to lower levels [4,12,15]. As MAP<65 mmHg is a potentially better surrogate of hypoperfusion, we assume that our protocol enabled us to promote patient safety [3], but a further evaluation of hard endpoints is needed.…”

“…As the aforementioned guidelines promote restrictive intra-and postoperative uid therapy, it is vital to identify patients at risk before procedures. Point-of-care ultrasound was veri ed as a promising non-invasive method in several studies, where results offered pointing out patients with a potentially modi able risk [12,14,15,17]. Despite its obvious limitations (e.g., respiratory efforts, right ventricular dysfunction, pericardial disease, higher intraabdominal pressures) [34], the measurement of IVCCI was validated as a tool to guide uid load before subarachnoid blockade and it effectively helped prevent hypotension [16,17].…”

“…Sample size calculations were made based on the primary outcome and the characteristics of preoperative uid therapy. The reported incidence of early intraoperative hypotension is reported in a range of 30-51% [12]. We assumed that it is possible to reduce the risk to 10-25% (absolute risk).…”

“…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 [8,9] than in the case of mechanical ventilation [10,11], several studies including our previous experiences identi ed their potential role prior to general anaesthesia [12][13][14][15]. 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 [12], the feasibility of the evaluation of IVC collapsibility index (further IVCCI) still makes it a potential choice to guide perioperative uid therapy.…”

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

“…Despite the encouraging findings, the sensitivity and specificity of dIVC max in predicting PIH are far from the levels required for use in daily practice. In a previous study by Aissaoui et al ( 21 ), ΔVTI-PLR (velocity time integral of the left ventricular outflow tract changes induced by passive leg raise) predicted PIH with a 0.89 AUC under the ROC curve (95% CI: 0.80–0.97) at a cutoff of 18% (88% sensitivity and 84% specificity) in patients >50 years of age. Similar to ultrasound-based IVC parameters ( 22 ), the mechanism of ΔVTI-PLR in predicting PIH is based on fluid responsiveness assessment ( 23 ).…”