Background Intraoperative hypotension increases 30-day mortality and the risks of myocardial injury and acute renal failure. Patients with inadequate volume reserve before the induction of anesthesia are highly exposed. The identification of latent hypovolemia is therefore crucial. Ultrasonographic measurement of the inferior vena cava collapsibility index (IVCCI) is able to detect volume responsiveness in circulatory shock. No current evidence is available regarding whether preoperative measurement of the IVCCI could identify patients at high risk for hypotension associated with general anesthesia. Methods A total of 102 patients undergoing elective general surgery under general anesthesia with standardized propofol induction were recruited for this prospective observational study. The IVCCI was measured under spontaneous breathing. A collapsing (IVCCI≧50%) (CI+) and a noncollapsing (CI-) group were formed. Immediate postinduction changes in systolic and mean blood pressure were compared. The performance of the IVCCI as a diagnostic tool for predicting hypotension (systolic pressure < 90 mmHg or a ≥ 30% drop from the baseline) was evaluated by ROC curve analysis. Results A total of 83 patients were available for analysis, with 20 in the CI+ and 63 in the CI- group, we excluded 19 previously eligible patients due to inadequate visualization of the IVC (7 cases), lack of adherence to the protocol (8 cases), missing data (2 cases) or change in anesthesiologic management (2 cases). The mean decrease in systolic pressure in the CI+ group was 53.8 ± 15.3 compared to 35.8 ± 18.1 mmHg in CI- patients ( P = 0.0001). The relative mean arterial pressure change medians were 34.1% (IQR 23.2–43.0%) and 24.2% (IQR 17.2–30.2%), respectively ( P = 0.0029). The ROC curve analysis for IVCCI showed an AUC of 64.8% (95% CI 52.1–77.5%). The selected 50% level of the IVCCI had a sensitivity of only 45.5% (95% CI 28.1–63.7%), but the specificity was high at 90.0% (78.2–96.7%). The positive predictive value was 75.0% (95% CI 50.9–91.3%), and the negative predictive value was 71.4% (95% CI 58.7–82.1%). Conclusion In spontaneously breathing preoperative noncardiac surgical patients, preoperatively detected IVCCI≧50% can predict postinduction hypotension with high specificity but low sensitivity. Despite moderate performance, IVCCI is an easy, noninvasive and attractive option to identify patients at risk and should be explored further. Electronic supplementary material The online version of this article (10.1186/s12871-019-0809-4) contains supplementary material, which is available to authorized users.

Background Postoperative pulmonary complications (PPCs) are important contributors to mortality and morbidity after surgery. The available predicting models are useful in preoperative risk assessment, but there is a need for validated tools for the early postoperative period as well. Lung ultrasound is becoming popular in intensive and perioperative care and there is a growing interest to evaluate its role in the detection of postoperative pulmonary pathologies. Objectives We aimed to identify characteristics with the potential of recognizing patients at risk by comparing the lung ultrasound scores (LUS) of patients with/without PPC in a 24-h postoperative timeframe. Methods Observational study at a university clinic. We recruited ASA 2–3 patients undergoing elective major abdominal surgery under general anaesthesia. LUS was assessed preoperatively, and also 1 and 24 h after surgery. Baseline and operative characteristics were also collected. A one-week follow up identified PPC+ and PPC- patients. Significantly differing LUS values underwent ROC analysis. A multi-variate logistic regression analysis with forward stepwise model building was performed to find independent predictors of PPCs. Results Out of the 77 recruited patients, 67 were included in the study. We evaluated 18 patients in the PPC+ and 49 in the PPC- group. Mean ages were 68.4 ± 10.2 and 66.4 ± 9.6 years, respectively (p = 0.4829). Patients conforming to ASA 3 class were significantly more represented in the PPC+ group (66.7 and 26.5%; p = 0.0026). LUS at baseline and in the postoperative hour were similar in both populations. The median LUS at 0 h was 1.5 (IQR 1–2) and 1 (IQR 0–2; p = 0.4625) in the PPC+ and PPC- groups, respectively. In the first postoperative hour, both groups had a marked increase, resulting in scores of 6.5 (IQR 3–9) and 5 (IQR 3–7; p = 0.1925). However, in the 24th hour, median LUS were significantly higher in the PPC+ group (6; IQR 6–10 vs 3; IQR 2–4; p < 0.0001) and it was an independent risk factor (OR = 2.6448 CI95% 1.5555–4.4971; p = 0.0003). ROC analysis identified the optimal cut-off at 5 points with high sensitivity (0.9444) and good specificity (0.7755). Conclusion Postoperative LUS at 24 h can identify patients at risk of or in an early phase of PPCs.

Background: Intraoperative hypotension increases 30-day mortality and the risks of myocardial injury and acute renal failure. Patients with inadequate volume reserve before the induction of anesthesia are highly exposed. The identification of latent hypovolemia is therefore crucial. Ultrasonographic measurement of the inferior vena cava collapsibility index (IVCCI) is able to detect volume responsiveness in circulatory shock. No current evidence is available regarding whether preoperative measurement of the IVCCI could identify patients at high risk for hypotension associated with general anesthesia. Methods: A total of 102 patients undergoing elective general surgery under general anesthesia with standardized propofol induction were recruited for this prospective observational study. The IVCCI was measured under spontaneous breathing. A collapsing (IVCCI≧50%) (CI+) and a noncollapsing (CI-) group were formed. Immediate postinduction changes in systolic and mean blood pressure were compared. The performance of the IVCCI as a diagnostic tool for predicting hypotension (systolic pressure <90 mmHg or a ≥30% drop from the baseline) was evaluated by ROC curve analysis. Results: A total of 83 patients were available for analysis, with 20 in the CI+ and 63 in the CI- group, we excluded 19 previously eligible patients due to inadequate visualization of the IVC (7 cases), lack of adherence to the protocol (8 cases), missing data (2 cases) or change in anesthesiologic management (2 cases). The mean decrease in systolic pressure in the CI+ group was 53.8±15.3 compared to 35.8±18.1 mmHg in CI- patients (P=0.0001). The relative mean arterial pressure change medians were 34.1% (IQR 23.2%-43.0%) and 24.2% (IQR 17.2%-30.2%), respectively (P=0.0029). The ROC curve analysis for IVCCI showed an AUC of 64.8% (95%CI 52.1-77.5%). The selected 50% level of the IVCCI had a sensitivity of only 45.5% (95%CI 28.1-63.7%), but the specificity was high at 90.0% (78.2-96.7%). The positive predictive value was 75.0% (95%CI 50.9-91.3%), and the negative predictive value was 71.4% (95%CI 58.7-82.1%). Conclusion: In spontaneously breathing preoperative noncardiac surgical patients, preoperatively detected IVCCI≧50% can predict postinduction hypotension with high specificity but low sensitivity. Despite moderate performance, IVCCI is an easy, noninvasive and attractive option to identify patients at risk and should be explored further.

Background: Intraoperative hypotension increases 30-day mortality and the risks of myocardial injury and acute renal failure. Patients with inadequate volume reserve before the induction of anesthesia are highly exposed. The identification of latent hypovolemia is therefore crucial. Ultrasonographic measurement of the inferior vena cava collapsibility index (IVCCI) is able to detect volume responsiveness in circulatory shock. No current evidence is available regarding whether preoperative measurement of the IVCCI could identify patients at high risk for hypotension associated with general anesthesia. Methods: A total of 102 patients undergoing elective general surgery under general anesthesia with standardized propofol induction were recruited for this prospective observational study. The IVCCI was measured under spontaneous breathing. A collapsing (IVCCI≧50%) (CI+) and a noncollapsing (CI-) group were formed. Immediate postinduction changes in systolic and mean blood pressure were compared. The performance of the IVCCI as a diagnostic tool for predicting hypotension (systolic pressure <90 mmHg or a ≥30% drop from the baseline) was evaluated by ROC curve analysis. Results: A total of 83 patients were available for analysis, with 20 in the CI+ and 63 in the CI- group, we excluded 19 previously eligible patients due to inadequate visualization of the IVC (7 cases), lack of adherence to the protocol (8 cases), missing data (2 cases) or change in anesthesiologic management (2 cases). The mean decrease in systolic pressure in the CI+ group was 53.8±15.3 compared to 35.8±18.1 mmHg in CI- patients (P=0.0001). The relative mean arterial pressure change medians were 34.1% (IQR 23.2%-43.0%) and 24.2% (IQR 17.2%-30.2%), respectively (P=0.0029). The ROC curve analysis for IVCCI showed an AUC of 64.8% (95%CI 52.1-77.5%). The selected 50% level of the IVCCI had a sensitivity of only 45.5% (95%CI 28.1-63.7%), but the specificity was high at 90.0% (78.2-96.7%). The positive predictive value was 75.0% (95%CI 50.9-91.3%), and the negative predictive value was 71.4% (95%CI 58.7-82.1%). Conclusion: In spontaneously breathing preoperative noncardiac surgical patients, preoperatively detected IVCCI≧50% can predict postinduction hypotension with high specificity but low sensitivity. Despite moderate performance, IVCCI is an easy, noninvasive and attractive option to identify patients at risk and should be explored further.

Background: Intraoperative hypotension increases 30-day mortality, risk of myocardial injury and acute renal failure. Patients having inadequate volume reserve before induction of anesthesia are highly exposed. Identification of subclinical hypovolemia is therefore crucial. Ultrasonographic measurement of inferior vena cava collapsibility index (IVCCI) is able to detect volume responsiveness in circulatory shock. Ther is a lack of current evidence whether preoperative application could identify high risk patients for hypotension associated to general anesthesia. Methods: 102 patients (conforming ASA status I-III, without significant cardiac pathology) undergoing elective abdominal surgery under general anesthesia with standardized propofol induction were recruited to this prospective observational study. IVCCI was measured under spontaneous breathing. A collapsing (IVCCI≧50%) (CI+) and a non-collapsing (CI-) group were formed. Immediate postinductional changes in systolic and mean blood pressure were compared. Performance of IVCCI’s 50% cut-off as a diagnostic tool for predicting hypotension (systolic pressure below 90 mmHg or >30% drop from baseline) was evaluated by ROC curve analysis. Results: A total of 83 patients were evaluated, 20 in the CI+ and 63 in the CI- group. Mean decrease of systolic pressure in CI- group was 35.8±18.1 mmHg compared to 53.8±15.3 mmHg of CI+ patients (P=0.0001). Relative decrease in systolic pressures differed significantly as well: CI- patients had a mean of 24.7±11.3% while this was 36.4±9.1% in CI+ group (P<0.0001). Relative mean arterial pressure change medians were 24.2% (IQR 17.2%-30.2%) and 34.1% (IQR 23.2%-43.0%) respectively (P=0.0029). The ROC-curve analysis for IVCCI showed an AUC of 64.8% (95%CI 52.1-77.5%). Selected 50% level of IVCCI had a sensitivity of only 45.5% (95%CI 28.1-63.7%) but specificity was high: 90.0% (78.2-96.7%). Positive predictive value revealed as 75.0% (95%CI 50.9-91.3%) and negative predictive value was 71.4% (95%CI 58.7-82.1%). Conclusion: Preoperatively detected IVCCI≧50% is a moderately useful test to identify patients susceptible to postinductional hypotension. However, due to its low sensitivity, it has a low value in excluding it. Keywords: Anesthesia, hypotension, propofol, vena cava, inferior, echocardiography