Maximum inferior vena cava diameter predicts post-induction hypotension in hypertensive patients undergoing non-cardiac surgery under general anesthesia: A prospective cohort study

Hanying Zhang, Hongguang Gao, Yuanjun Xiang, Junxiang Li, Hanying Zhang, Hongguang Gao, Yuanjun Xiang, Junxiang Li

Abstract

Background: Inferior vena cava (IVC) ultrasonography is a reliable variable that predicts post-induction hypotension (PIH) in patients undergoing surgery under general anesthesia. However, in patients with hypertension, the predictive performance of ultrasound IVC measurements needs further exploration.

Methods: This is a prospective cohort study. Adult patients with existing hypertension scheduled to undergo non-cardiac surgery under general anesthesia were eligible. An abdominal ultrasound examination was conducted immediately prior to anesthesia induction (0.03 mg kg-1 midazolam, 0.3 mg kg-1 etomidate, 0.4 μg kg-1 sufentanil, and 0.6 mg kg-1 rocuronium). IVC collapsibility index (IVC-CI) was calculated as (dIVCmax-dIVCmin)/dIVCmax, where dIVCmax and dIVCmin represent the maximum and minimum IVC diameters at the end of expiration and inspiration, respectively. PIH was defined as a reduction of mean arterial pressure (MAP) by >30% of the baseline or to <60 mmHg within 10 min after endotracheal intubation. The diagnostic performance of IVC-CI, dIVCmax, and dIVCmin in predicting PIH was also examined in a group of normotensive patients receiving non-cardiac surgery under the same anesthesia protocol.

Results: A total of 51 hypertensive patients (61 ± 13 years of age, 31 women) and 52 normotensive patients (42 ± 13 years of age, 35 women) were included in the final analysis. PIH occurred in 33 (64.7%) hypertensive patients and 19 (36.5%) normotensive patients. In normotensive patients, the area under the receiver operating curve (AUC) in predicting PIH was 0.896 (95% confidence interval [CI]: 0.804-0.987) for IVC-CI, 0.770 (95% CI: 0.633-0.908) for dIVCmax, and 0.868 (95% CI: 0.773-0.963) for dIVCmin. In hypertensive patients, the AUC in predicting PIH was 0.523 (95% CI: 0.354-0.691) for IVC-CI, 0.752 (95% CI: 0.621-0.883) for dIVCmax, and 0.715 (95% CI: 0.571-0.858) for dIVCmin. At the optimal cutoff (1.24 cm), dIVCmax had 54.5% (18/33) sensitivity and 94.4% (17/18) specificity.

Conclusion: In hypertensive patients, IVC-CI is unsuitable for predicting PIH, and dIVCmax is an alternative measure with promising performance.

Clinical trial registration: [http://www.chictr.org.cn/], identifier [ChiCTR2000034853].

Keywords: general anesthesia; hypertension; inferior vena cava; post-induction hypotension; ultrasound.

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Copyright © 2022 Zhang, Gao, Xiang and Li.

Figures

FIGURE 1
FIGURE 1
Ultrasound measurements of the inferior vena cava. dIVCmax, maximum inferior vena cava diameter; dIVCmin, minimum inferior vena cava diameter; IVC-CI, collapsibility index of inferior vena cava.
FIGURE 2
FIGURE 2
Flowchart of the hypertensive and normotensive group.
FIGURE 3
FIGURE 3
Receiver operating characteristic curves. (A) IVC-CI in predicting PIH in normotensive patients; (B) dIVCmax in predicting PIH in normotensive patients; (C) dIVCmin in predicting PIH in normotensive patients; (D) IVC-CI in predicting PIH in hypertensive patients; (E) dIVCmax in predicting PIH in hypertensive patients; and (F) dIVCmin in predicting PIH in hypertensive patients.

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