Preoperative assessment of inferior vena cava collapsibility index by ultrasound is not a reliable predictor of post-spinal anesthesia hypotension
A avaliação pré-operatória do índice de colapsibilidade da veia cava inferior por ultrassonografia não é um preditor confiável de hipotensão pós-raquianestesia
Shayak Roy, Nikhil Kothari, Shilpa Goyal, Ankur Sharma, Rakesh Kumar, Narender Kaloria, Pradeep Bhatia
Abstract
Background
Post-spinal anesthesia hypotension is of common occurrence, and it hampers tissue perfusion. Several preoperative factors determine patient susceptibility to hypotension. This study aimed to assess the effectiveness of the Inferior Vena Cava Collapsibility Index (IVCCI) for predicting intraoperative hypotension.
Methods
One hundred twenty-nine adult patients who were scheduled for elective surgical procedures after administration of spinal (intrathecal) anesthesia were included in the study. Ultrasound evaluation of the Inferior Vena Cava (IVC) was done in the preoperative area, and the patients were shifted to the Operating Room (OR) for spinal anesthesia. An independent observer recorded the change in blood pressure after spinal anesthesia inside the OR.
Results
Twenty-five patients developed hypotension (19.37%). Baseline systolic blood pressure and mean blood pressures were statistically higher in those patients who developed hypotension (p = 0.001). The logistic regression analysis for IVCCI and the incidence of hypotension showed r2 of 0.025. Receiver Operating Characteristic (ROC) curve analysis demonstrated the Area Under the Curve (AUC) of 0.467 (95% Confidence Interval, 0.338 to 0.597; p = 0.615).
Conclusions
Preoperative evaluation of IVCCI is not a good predictor for the occurrence of hypotension after spinal anesthesia.
Keywords
Resumo
Introdução
A hipotensão pós-raquianestesia é comum e dificulta a perfusão tecidual. Vários fatores pré-operatórios determinam a suscetibilidade do paciente à hipotensão. Este estudo teve como objetivo avaliar a eficácia do Índice de Colapsibilidade da Veia Cava Inferior (ICVCI) para prever a hipotensão intraoperatória.
Métodos
Cento e vinte e nove pacientes adultos agendados para procedimentos cirúrgicos eletivos após a administração de raquianestesia (intratecal) foram incluídos no estudo. A avaliação ultrassonográfica da veia cava inferior (VCI) foi realizada no pré-operatório e os pacientes foram encaminhados ao Centro Cirúrgico (CC) para raquianestesia. Um observador independente registrou a mudança na pressão arterial após raquianestesia dentro da sala de cirurgia.
Resultados
Vinte e cinco pacientes desenvolveram hipotensão (19,37%). A pressão arterial sistólica basal e a pressão arterial média foram estatisticamente maiores nos pacientes que desenvolveram hipotensão (p = 0,001). A análise de regressão logística para ICVCI e incidência de hipotensão apresentou r2 de 0,025. A análise da curva Receiver Operating Characteristic (ROC) demonstrou a área sob a curva (AUC) de 0,467 (intervalo de confiança de 95%, 0,338 a 0,597; p = 0,615).
Conclusões
A avaliação pré-operatória de ICVCI não é um bom preditor para a ocorrência de hipotensão após raquianestesia.
Palavras-chave
References
1. Bajwa S, Jindal R, Kulshrestha A. Co-loading or preloading for prevention of hypotension after spinal anesthesia! a therapeutic dilemma. Anesth Essays Res. 2013;7:155−9.
2. Khan MU, Memon AS, Ishaq M, et al. Preload versus coload and vasopressor requirement to prevent spinal anesthesia-induced hypotension in non-obstetric patients. J Coll Physicians Surg Pak. 2015;25:851−5.
3. Ceruti S, Anselmi L, Minotti B, et al. Prevention of arterial hypotension after spinal anesthesia using vena cava ultrasound to guide fluid management. Br J Anaesth. 2018;120:101−8.
4. Fawcett WJ, Thomas M. Pre-operative fasting in adults and children: clinical practice and guidelines. Anaesthesia. 2019;74:83−8.
5. Voldby AW, Brandstrup B. Fluid therapy in the perioperative setting-a clinical review. J Intensive Care. 2016;4:27.
6. Muller L, Briere M, Bastide S, et al. Preoperative fasting does not affect haemodynamic status: a prospective, non-inferiority, echocardiography study. Br J Anaesth. 2014;112:835−41.
7. Rudski LG, Lai WW, Afilalo J, et al. Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography. J Am Soc Echocardiogr. 2010;23:685−713.
8. Karacabey S, Sanri E, Guneysel O. A noninvasive method for assessment of intravascular fluid status: inferior vena cava diameters and collapsibility index. Pak J Med Sci. 2016;32:836.
9. Zhang J, Critchley LA. Inferior vena cava ultrasonography before general anesthesia can predict hypotension after induction. Anesthesiology. 2016;124:580−9.
10. Zhang Z, Xu X, Ye S, et al. Ultrasonographic measurement of the respiratory variation in the inferior vena cava diameter is predictive of fluid responsiveness in critically ill patients: systematic review and meta-analysis. Ultrasound Med Biol. 2014;40:845−53.
11. Salama E, Elkashlan M. Pre-operative ultrasonographic evaluation of inferior vena cava collapsibility index and caval aorta index as new predictors for hypotension after induction of spinal anaesthesia. Eur J Anaesthesiol. 2019;36:297−302.
12. Bijker JB, van Klei WA, Kappen TH, et al. Incidence of intraoperative hypotension as a function of the chosen definition: literature definitions applied to a retrospective cohort using automated data collection. Anesthesiology. 2007;107:213−20.
13. Thanakitcharu P, Charoenwut M, Siriwiwatanakul N. Inferior vena cava diameter and collapsibility index: a practical noninvasive evaluation of intravascular fluid volume in critically ill patients. J Med Assoc Thai. 2013;96:S14−22.
14. Kent A, Bahner DP, Boulger CT, et al. Sonographic evaluation of intravascular volume status in the surgical intensive care unit: a prospective comparison of subclavian vein and inferior vena cava collapsibility index. J Surg Res. 2013;184:561−6.
15. Yavasi¸ O, € Unl € uer EE, Kayayurt K, et al. Monitoring the response € to treatment of acute heart failure patients by ultrasonographic inferior vena cava collapsibility index. Am J Emerg Med. 2014;32:403−7.
16. Pasquero P, Albani S, Sitia E, et al. Inferior vena cava diameters and collapsibility index reveal early volume depletion in a blood donor model. Crit Ultrasound J. 2015;7:17.
17. Zhao J, Wang G. Inferior vena cava collapsibility index is a valuable and non-invasive index for elevated general heart end-diastolic volume index estimation in septic shock patients. Med Sci Monit. 2016;22:3843−8.
18. Cannesson M, Pestel G, Ricks C, et al. Hemodynamic monitoring and management in patients undergoing high risk surgery: a survey among North American and European anesthesiologists. Crit Care. 2011;15:R197.
19. Zengin S, Al B, Genc S, et al. Role of inferior vena cava and right ventricular diameter in assessment of volume status: a comparative study: ultrasound and hypovolemia. Am J Emerg Med. 2013;31:763−7.
20. Seif D, Mailhot T, Perera P, et al. Caval sonography in shock: a noninvasive method for evaluating intravascular volume in critically ill patients. J Ultrasound Med. 2012;31:1885−90.
21. Wallace DJ, Allison M, Stone MB. Inferior vena cava percentage collapse during respiration is affected by the sampling location: an ultrasound study in healthy volunteers. Acad Emerg Med. 2010;17:96−9.
22. Dust A, Zogheib E, Guinot P, et al. The gray zone of the qualitative assessment of respiratory changes in inferior vena cava diameter in ICU patients. Crit Care. 2014;18:R14. Brazilian Journal of Anesthesiology 2023;73(4): 385−392
23. Ayyanagouda B, Ajay BC, Joshi C, et al. Role of ultrasonographic inferior vena cava assessment in averting spinal anaesthesiainduced hypotension for hernia and hydrocele surgeries ‒ A prospective randomised controlled study. Indian J Anaesth. 2020;64:849−54.
24. Misurata H, Senda S, Okuyama H, et al. Age-related decrease in inferior vena cava diameter measured with echocardiography. Tohoku J Exp Med. 2010;222:141−7.
25. Gui J, Guo J, Nong F, et al. impact of individual characteristics on sonographic IVC diameter and the IVC diameter/aorta diameter index. Am J Emerg Med. 2015;33:1602−5.
26. Maciuliene A, Gelmanas A, Jaremko I, et al. Measurements of inferior vena cava diameter for prediction of hypotension and bradycardia during spinal anesthesia in spontaneously breathing patients during elective knee joint replacement surgery. Medicine (Kaunas.). 2018;54:49.
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