Background: Hypotension is often occurring after induction of general anesthesia (IGA) and can cause organ
hypoperfusion and ischemia which associated with adverse outcomes in patients having both cardiac and noncardiac surgery. Elderly patients are particularly more vulnerable and at increased risk to the depressant effect of
anesthetic drugs. So, recognition and prevention of such event are of clinical importance. This study recruited
patients aged above 60 years, with ASA physical status classification I-II-III who were scheduled for surgery under
general anesthesia with the aim to assess the effectiveness of preoperative IVC ultrasonography in predicting
hypotension which develops following IGA and its association with the volume status in elderly patients receiving
general anesthesia, through measurements of the maximum inferior vena cava diameter (dIVCmax), minimum
inferior vena cava diameter (dIVCmin), inferior vena cava collapsibility index (IVC-CI), and basal and post-induction
mean arterial pressure (MAP).
Results: Thirty-nine (44.3%) of the 88 patients developed hypotension after IGA, and it was significantly more in
patients who did not receive preoperative fluid (p = 0.045). The cut-off for dIVCmax was found as 16.250 mm with
the ROC analysis. Specificity and sensitivity for the cut-off value of 16.250 mm were calculated as 61.2% and 76.9%,
respectively. The cut-off for IVC-CI was found as 33.600% with the ROC analysis. Specificity and sensitivity for the
cut-off value of 33.600% were calculated as 68.7% and 87.2%, respectively.
Conclusions: IVC ultrasonography may be helpful in the prediction of preoperative hypovolemia in elderly patients
in the form of high IVC-CI and low dIVCmax. The incidence of hypotension was lower in patients who received
fluid infusion before IGA. |
