Inferior Vena Cava Ultrasonography before General Anesthesia Can Predict Hypotension after Induction

Background:

Hypotension is a common side effect of general anesthesia induction, and when severe, it is related to adverse outcomes. Ultrasonography of inferior vena cava (IVC) is a reliable indicator of intravascular volume status. This study investigated whether preoperative ultrasound IVC measurements could predict hypotension after induction of anesthesia.

Methods:

One hundred four adult patients, conforming to American Society of Anesthesiologists physical status I to III, scheduled for elective surgery after general anesthesia were recruited. Maximum IVC diameter (dIVC_max) and collapsibility index (CI) were measured preoperatively. Before induction, mean blood pressure (MBP) was recorded. After induction, MBP was recorded for 10 min after intubation. Hypotension was defined as greater than 30% decrease in MBP from baseline or MBP less than 60 mmHg. Receiver operating characteristic curve analysis with gray zone approach and regression analyses were used.

Results:

IVC scanning was unsuccessful in 13.5% of patients. Data from 90 patients were analyzed. After induction, 42 patients developed hypotension. Areas (95% confidence interval) under the curves were 0.90 (0.82 to 0.95) for CI and 0.76 (0.66 to 0.84) for dIVC_max. The optimal cutoff values were 43% for CI and 1.8 cm for dIVC_max. The gray zone for CI was 38 to 43% and included 12% of patients and that for dIVC_max was 1.5 to 2.1 cm and included 59% of patients. After adjusting for other factors, it was found that CI was an independent predictor of hypotension with the odds ratio of 1.17 (1.09 to 1.26). CI was also positively associated with a percentage decrease in MBP (regression coefficient = 0.27).

Conclusions:

Preoperative ultrasound IVC CI measurement was a reliable predictor of hypotension after induction of general anesthesia, wherein CI greater than 43% was the threshold.