Accuracy of preoperative evaluation of inferior vena cava collapsibility index and caval aorta index for prediction of hypotension after induction of general anesthesia: a prospective observational study | [Anaesthesia, Pain and Intensive Care • 2023]

Author(s):

1. Heba Omar: Faculty of Medicine, Cairo University,Kasr Alainy Street, Cairo,Egypt

2. Ahmed Moamen: Faculty of Medicine, Cairo University,Kasr Alainy Street, Cairo,Egypt

3. Bassant Mohamed Abdelhamid: Faculty of Medicine, Cairo University,Kasr Alainy Street, Cairo,Egypt

4. Ashraf Rady: Faculty of Medicine, Cairo University,Kasr Alainy Street, Cairo,Egypt

5. Inas Farouk: Faculty of Medicine, Cairo University,Kasr Alainy Street, Cairo,Egypt

Abstract:

Background & Objective: Post general anesthesia induction hypotension (PGAH) is not a rare event. Almost every induction agent has been incriminated to a variable extent. Preoperative ultrasound assessment of Inferior Vena Cava Collapsibility Index (IVCCI) has been investigated for predicting hypotension with mixed results. Inferior vena cava to aorta diameter index (IVC/Ao) hasn't been studied before as a predictor for PGAH. We studied the comparative accuracy of preoperative IVCC and IVC/Ao index for PGAH prediction. Methodology: This observational prospective blinded study involved 102 participants undergoing different surgeries under general anesthesia. Preoperative ultrasound assessment of IVCCI and IVC/Ao index was done. Mean arterial pressure (MAP) was assessed 6 times; before induction, 1 min and 3 min after induction and 1, 5 and 10 min after endotracheal intubation. The area under the receiver operating characteristic curve (AUROC) was calculated for the ability of IVCC and IVC/Ao index to predict PGAH. Stepwise, backward logistic regression model was constructed to detect and quantify the predictive factors of PGAH. Results: A total of 80 (78.43%) patients developed PGAH. ROC curve analysis for PGAH prediction demonstrated better diagnostic accuracy for IVC/Ao index than IVCCI, as the AUC of both were 0.666 (P < 0.017) and 0.487 (P = 0.852) respectively. IVC/Ao index cutoff value was 0.852 Conclusions: Inferior vena cava collapsibility index and inferior vena cava to aorta diameter ratio (IVC/Ao) index are both reliable indicators of post general anesthesia induction hypotension. IVC/Ao index is a more accurate and reliable indicator than inferior vena cava collapsibility index.

Page(s): 448-455

DOI: 10.35975/apic.v27i4.2255

Published: Journal: Anaesthesia, Pain and Intensive Care, Volume: 27, Issue: 3, Year: 2023

Keywords:

Hypotension , Ultrasound , Aorta , general anesthesia , IVCCI

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