Ultrasound measurement of inferior vena cava collapsibility as a tool to predict propofol-induced hypotension

Purushothaman, Shyam Sundar; Alex, Ani; Kesavan, Rajesh; Balakrishnan, Sindhu; Rajan, Sunil; Kumar, Lakshmi

doi:10.4103/aer.aer_75_20

Cited by 19 publications

(16 citation statements)

References 15 publications

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“…The optimal IVC-CI cutoff in normotensive patients (43%) was consistent with a previous study by Purushothaman et al ( 16 ), who selected propofol as the anesthesia inducer. The optimal dIVC max cutoff in normotensive patients (1.29 cm) was comparable to previous studies ( 13 ).…”

Section: Discussionsupporting

confidence: 89%

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: 89%

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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“…[ 17 ] These parameters have also been used to predict hypotension after induction of GA in mixed population of patients with variable results. [ 7 18 19 20 21 ] We believe that for becoming accurate predictors of post-induction hypotension, these parameters must be applicable over the entire range of surgical patients with volume deficit. Previous studies done on this subject have enroled a mixed population of patients expected to experience higher post-induction hypotension in view of the presence of other predictors of post-induction hypotension.…”

Section: Discussionmentioning

confidence: 99%

Prediction of post-induction hypotension in young adults using ultrasound-derived inferior vena cava parameters: An observational study

Mohammed¹,

Syal²,

Bhatia³

et al. 2021

Indian J Anaesth

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Background and Aims: Inferior vena cava (IVC) diameter and its respiratory variability have been shown to predict post-induction hypotension with high specificity in a mixed population of patients. We assessed whether these parameters could be as reliable in healthy adult patients as in a mixed patient population. Methods: In the present prospective observational study, 110 patients of either sex, aged between 18 and 50 years, belonging to American Society of Anesthesiologists class I and II, fasted as per the institutional protocol and scheduled for elective surgery under general anaesthesia were enroled. Prior to induction, ultrasound examination of IVC was done and variation in IVC diameter with respiration was assessed. Maximum and minimum IVC diameters [(dIVC max ) and (dIVC min ), respectively] over a single respiratory cycle were measured and collapsibility index (CI) was calculated. Vitals were recorded just before induction and at every minute after induction for 10 min. Episodes of hypotension (mean arterial pressure [MAP] <65 mmHg or fall in MAP >30% from baseline) during the observation period were recorded. The receiver operating characteristic (ROC) curve was constructed for determining optimum cut-off with sensitivity and specificity of IVC diameters and CI for development of hypotension. Results: IVC was not visualised in 22 patients. Out of the remaining 88 patients, 17 (19.3%) patients developed hypotension after induction. The dIVC max , dIVC min and CI were comparable between patients who developed and who did not develop hypotension. The area under curve of ROC for CI, dIVC max and dIVC min was 0.51, 0.55 and 0.52, respectively, with optimum cut-off value of 0.46, 1.42 and 0.73, respectively. Conclusion: Ultrasound-derived IVC parameters demonstrate poor diagnostic accuracy for prediction of hypotension after induction in healthy adult patients.

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“…Propofol is usually administered as a single bolus dose calculated based on the patients' body weight; however, there are individual differences in the tolerance to anesthetics. 37 Moreover, the bolus method might cause overdosage 38 or underdosage. 39 In our study, patients in the titrated group were successfully intubated without intraoperative awareness, which suggested that titrated propofol administration could allow an appropriate depth of anesthesia.…”

Section: Discussionmentioning

confidence: 99%

Observer’s Assessment of Alertness/Sedation-based titration reduces propofol consumption and incidence of hypotension during general anesthesia induction: A randomized controlled trial

et al. 2021

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Administration of a single propofol bolus dose for anesthesia induction causes hypotension. We included 160 patients (74 males and 86 females; mean age, 42.4 ± 10.7 [range: 18–60] years) with the American Society of Anesthesiologists status I–II undergoing elective surgery under general anesthesia. Using simple randomization, the patients were divided into a conventional group ( n = 80; received 2 mg/kg propofol at a rate of 250 mg/min) and titrated group ( n = 80; received propofol at a rate of 1 mg/kg/min until the Observer's Assessment of Alertness/Sedation scale score reached 1 point). Fentanyl (4 µg/kg) and cisatracurium (0.2 mg/kg) were administered, as appropriate. Systolic blood pressure, diastolic blood pressure, mean blood pressure, and heart rate were recorded at different time points. Propofol consumption, hypotension, and other adverse events were recorded. All the patients were intubated without awareness. Compared with the conventional group, the titrated group showed more stable blood pressure ( p < 0.05), as well as a lower decrease in systolic blood pressure, mean blood pressure at 1 and 3 min, and diastolic blood pressure at 1 min after propofol administration ( p < 0.01). Moreover, compared with the conventional group, the titrated group showed a lower post-intubation hypotension incidence (9 vs. 19 cases; p = 0.04), as well as lower total propofol dosage and propofol dose per kilogram of body weight (93.57 ± 14.40 mg vs. 116.80 ± 22.37 mg and 1.73 ± 0.27 mg/kg vs. 2.02 ± 0.08 mg/kg, respectively, p < 0.01). Compared with conventional propofol usage, titrated propofol administration can reduce the incidence of hypotension and propofol consumption during anesthesia induction.

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Ultrasound measurement of inferior vena cava collapsibility as a tool to predict propofol-induced hypotension

Cited by 19 publications

References 15 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

Prediction of post-induction hypotension in young adults using ultrasound-derived inferior vena cava parameters: An observational study

Observer’s Assessment of Alertness/Sedation-based titration reduces propofol consumption and incidence of hypotension during general anesthesia induction: A randomized controlled trial

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