Preoperative assessment of inferior vena cava collapsibility index by ultrasound is not a reliable predictor of post-spinal anesthesia hypotension
Shayak Roy, Nikhil Kothari, Shilpa Goyal, Ankur Sharma, Rakesh Kumar, Narender Kaloria, Pradeep Bhatia
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.
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.
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).
Preoperative evaluation of IVCCI is not a good predictor for the occurrence of hypotension after spinal anesthesia.
1 S Bajwa, R Jindal, A. Kulshrestha Co-loading or preloading for prevention of hypotension after spinal anesthesia! a therapeutic dilemma Anesth Essays Res, 7 (2013), pp. 155-159
2 MU Khan, AS Memon, M Ishaq, et al. Preload versus coload and vasopressor requirement to prevent spinal anesthesia-induced hypotension in non-obstetric patients J Coll Physicians Surg Pak, 25 (2015), pp. 851-855
3 S Ceruti, L Anselmi, B Minotti, et al. Prevention of arterial hypotension after spinal anesthesia using vena cava ultrasound to guide fluid management Br J Anaesth, 120 (2018), pp. 101-108
4 WJ Fawcett, M. Thomas Pre-operative fasting in adults and children: clinical practice and guidelines Anaesthesia, 74 (2019), pp. 83-88
5 AW Voldby, B. Brandstrup Fluid therapy in the perioperative setting-a clinical review J Intensive Care, 4 (2016), p. 27
6 L Muller, M Brière, S Bastide, et al. Preoperative fasting does not affect haemodynamic status: a prospective, non-inferiority, echocardiography study Br J Anaesth, 112 (2014), pp. 835-841
7 LG Rudski, WW Lai, J Afilalo, 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, 23 (2010), pp. 685-713
8 S Karacabey, E Sanri, O. Guneysel A noninvasive method for assessment of intravascular fluid status: inferior vena cava diameters and collapsibility index Pak J Med Sci, 32 (2016), p. 836
9 J Zhang, LA. Critchley Inferior vena cava ultrasonography before general anesthesia can predict hypotension after induction Anesthesiology, 124 (2016), pp. 580-589
10 Z Zhang, X Xu, S Ye, 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, 40 (2014), pp. 845-853
11 E Salama, M. Elkashlan 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, 36 (2019), pp. 297-302
12 JB Bijker, WA van Klei, TH Kappen, 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, 107 (2007), pp. 213-220
13 P Thanakitcharu, M Charoenwut, N. Siriwiwatanakul Inferior vena cava diameter and collapsibility index: a practical noninvasive evaluation of intravascular fluid volume in critically ill patients J Med Assoc Thai, 96 (2013), pp. S14-S22
14 A Kent, DP Bahner, CT Boulger, 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, 184 (2013), pp. 561-566
15 Ö Yavaşi, EE Ünlüer, K Kayayurt, et al. Monitoring the response to treatment of acute heart failure patients by ultrasonographic inferior vena cava collapsibility index Am J Emerg Med, 32 (2014), pp. 403-407
16 P Pasquero, S Albani, E Sitia, et al. Inferior vena cava diameters and collapsibility index reveal early volume depletion in a blood donor model Crit Ultrasound J, 7 (2015), p. 17
17 J Zhao, G. Wang 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, 22 (2016), pp. 3843-3848
18 M Cannesson, G Pestel, C Ricks, et al. Hemodynamic monitoring and management in patients undergoing high risk surgery: a survey among North American and European anesthesiologists Crit Care, 15 (2011), p. R197
19 S Zengin, B Al, S Genc, 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, 31 (2013), pp. 763-767
20 D Seif, T Mailhot, P Perera, et al. Caval sonography in shock: a noninvasive method for evaluating intravascular volume in critically ill patients J Ultrasound Med, 31 (2012), pp. 1885-1890
21 DJ Wallace, M Allison, MB. Stone Inferior vena cava percentage collapse during respiration is affected by the sampling location: an ultrasound study in healthy volunteers Acad Emerg Med, 17 (2010), pp. 96-99
22 A Dust, E Zogheib, P Guinot, et al. The gray zone of the qualitative assessment of respiratory changes in inferior vena cava diameter in ICU patients Crit Care, 18 (2014), p. R14
23 B Ayyanagouda, BC Ajay, C Joshi, et al. Role of ultrasonographic inferior vena cava assessment in averting spinal anaesthesia-induced hypotension for hernia and hydrocele surgeries ‒ A prospective randomised controlled study Indian J Anaesth, 64 (2020), pp. 849-854
24 H Misurata, S Senda, H Okuyama, et al. Age-related decrease in inferior vena cava diameter measured with echocardiography Tohoku J Exp Med, 222 (2010), pp. 141-147
25 J Gui, J Guo, F Nong, et al. impact of individual characteristics on sonographic IVC diameter and the IVC diameter/aorta diameter index Am J Emerg Med, 33 (2015), pp. 1602-1605
26 A Maciuliene, A Gelmanas, I Jaremko, 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.), 54 (2018), p. 49