Inferior vena cava diameter as a predicting factor for hypotension after induction of general anesthesia in elderly patients

Mapping Intimacies ◽

10.21203/rs.2.9688/v1 ◽

2019 ◽

Author(s):

TL Wu ◽

Guocan Yu

Keyword(s):

Inferior Vena Cava ◽

General Anesthesia ◽

Older Adult ◽

Older Patients ◽

Inferior Vena ◽

Vena Cava ◽

Adult Patients ◽

Inferior Vena Cava Diameter ◽

Group B ◽

Predicting Factor

Abstract Background: To evaluate the use of inferior vena cava diameter (IVCD) to predict post-induction of general anesthesia (IGA) hypotension in older patients. Methods: Part I involved 60 older patients undergoing general anesthesia for surgery (group T).We determined the optimal cutoff value (OCV) of the most sensitive index (MSI) (the collapsibility index (IVCci), distensibility index, or respiratory variation rate) that best predicted post-IGA hypotension in older adult patients. Part II involved 66 older adult patients who underwent general anesthesia for surgery. In accordance with the MSI determinde in part I, patients were divided into group B (MSI ≥ OCV, n=42) and group S (MSI

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Can vena cava ultrasound-guided volume repletion prevent general induced hypotension in elderly patients? A mini-fluid challenge

Ain-Shams Journal of Anesthesiology ◽

10.1186/s42077-021-00206-x ◽

2022 ◽

Vol 14 (1) ◽

Author(s):

Samar Rafik Amin ◽

Enas W. Mahdy

Keyword(s):

Inferior Vena Cava ◽

Elderly Patients ◽

General Anesthesia ◽

Roc Analysis ◽

Inferior Vena ◽

Vena Cava ◽

Anesthetic Drugs ◽

Specificity And Sensitivity ◽

Increased Risk ◽

Inferior Vena Cava Diameter

Abstract Background Hypotension is often occurring after induction of general anesthesia (IGA) and can cause organ hypoperfusion and ischemia which associated with adverse outcomes in patients having both cardiac and non-cardiac surgery. Elderly patients are particularly more vulnerable and at increased risk to the depressant effect of anesthetic drugs. So, recognition and prevention of such event are of clinical importance. This study recruited patients aged above 60 years, with ASA physical status classification I-II-III who were scheduled for surgery under general anesthesia with the aim to assess the effectiveness of preoperative IVC ultrasonography in predicting hypotension which develops following IGA and its association with the volume status in elderly patients receiving general anesthesia, through measurements of the maximum inferior vena cava diameter (dIVCmax), minimum inferior vena cava diameter (dIVCmin), inferior vena cava collapsibility index (IVC-CI), and basal and post-induction mean arterial pressure (MAP). Results Thirty-nine (44.3%) of the 88 patients developed hypotension after IGA, and it was significantly more in patients who did not receive preoperative fluid (p = 0.045). The cut-off for dIVCmax was found as 16.250 mm with the ROC analysis. Specificity and sensitivity for the cut-off value of 16.250 mm were calculated as 61.2% and 76.9%, respectively. The cut-off for IVC-CI was found as 33.600% with the ROC analysis. Specificity and sensitivity for the cut-off value of 33.600% were calculated as 68.7% and 87.2%, respectively. Conclusions IVC ultrasonography may be helpful in the prediction of preoperative hypovolemia in elderly patients in the form of high IVC-CI and low dIVCmax. The incidence of hypotension was lower in patients who received fluid infusion before IGA.

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Does respiratory variation in inferior vena cava diameter predict fluid responsiveness in adult patients? A systematic review and meta-analysis of diagnostic accuracy studies

Hong Kong Journal of Emergency Medicine ◽

10.1177/10249079211029781 ◽

2021 ◽

pp. 102490792110297

Author(s):

Ebru Unal Akoglu ◽

Haldun Akoglu

Keyword(s):

Inferior Vena Cava ◽

Diagnostic Accuracy ◽

Fluid Responsiveness ◽

Inferior Vena ◽

Meta Analysis ◽

Vena Cava ◽

Adult Patients ◽

Diagnostic Utility ◽

Respiratory Variation ◽

Inferior Vena Cava Diameter

Objectives: To systematically review the diagnostic utility of the respiratory variation of the inferior vena cava diameter measured using ultrasonography for predicting fluid responsiveness in adult patients and compare the three commonly used equations, inferior vena cava distensibility, inferior vena cava collapsibility and inferior vena cava variability. Methods: We searched PubMed, Scopus, Web of Science and Cochrane library, and included studies investigating the diagnostic accuracy of the respiratory variation of the inferior vena cava measured using ultrasonography compared to a reference standard for measuring cardiac output after a fluid challenge for fluid responsiveness, and stratified participants as fluid responsive or not. We included studies conducted in the emergency department or intensive care unit. We excluded studies on paediatric, prehospital, cancer, pregnant, dialysis patients or healthy volunteers. Results: We retrieved 270 records and excluded 171 because of irrelevance, patient population or publication type. We screened the abstracts of 99 studies and then the full texts of 42 studies. Overall, 21 studies with 1321 patients were included, of whom 689 (52%) were fluid responsive. The mean threshold value for positive inferior vena cava distensibility, inferior vena cava collapsibility and inferior vena cava variability was 17%, 35% and 12%, respectively. The heterogeneity between studies was high. Bivariate diagnostic random-effects meta-analysis was used to calculate the summary receiver operating characteristics curves. The overall accuracy, sensitivity and specificity of respiratory variation of the inferior vena cava diameter were 0.85, 0.72 and 0.81, respectively. The accuracy of inferior vena cava distensibility and inferior vena cava collapsibility was similar. The diagnostic utility of respiratory variation of the inferior vena cava diameter was lower but not statistically significant in mechanically ventilated patients compared with spontaneous breathing for predicting fluid responsiveness. Conclusion: The respiratory variation of the inferior vena cava diameter has moderate diagnostic utility for predicting fluid responsiveness independent of the equation used.

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