Role of ultrasonographic inferior venacaval assessment in averting spinal anaesthesia-induced hypotension for hernia and hydrocele surgeries—A prospective randomised controlled study

Ayyanagouda, Basavaraja; Ajay, B C; Joshi, Chhaya; Hulakund, Shivanand; Ganeshnavar, Anilkumar; Archana, Elangovan

doi:10.4103/ija.ija_244_20

Cited by 14 publications

(6 citation statements)

References 19 publications

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“…[ 6 ] Various studies have evaluated the role of the inferior vena cava (IVC) and its respiratory variability, that is collapsibility index (CI), as a predictor of hypotension both during induction of GA and after spinal anaesthesia in a mixed patient population. [ 7 8 ]…”

Section: Introductionmentioning

confidence: 99%

Prediction of post-induction hypotension in young adults using ultrasound-derived inferior vena cava parameters: An observational study

Mohammed¹,

Syal²,

Bhatia³

et al. 2021

Indian Journal of Anaesthesia

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Background and Aims: Inferior vena cava (IVC) diameter and its respiratory variability have been shown to predict post-induction hypotension with high specificity in a mixed population of patients. We assessed whether these parameters could be as reliable in healthy adult patients as in a mixed patient population. Methods: In the present prospective observational study, 110 patients of either sex, aged between 18 and 50 years, belonging to American Society of Anesthesiologists class I and II, fasted as per the institutional protocol and scheduled for elective surgery under general anaesthesia were enroled. Prior to induction, ultrasound examination of IVC was done and variation in IVC diameter with respiration was assessed. Maximum and minimum IVC diameters [(dIVC max ) and (dIVC min ), respectively] over a single respiratory cycle were measured and collapsibility index (CI) was calculated. Vitals were recorded just before induction and at every minute after induction for 10 min. Episodes of hypotension (mean arterial pressure [MAP] <65 mmHg or fall in MAP >30% from baseline) during the observation period were recorded. The receiver operating characteristic (ROC) curve was constructed for determining optimum cut-off with sensitivity and specificity of IVC diameters and CI for development of hypotension. Results: IVC was not visualised in 22 patients. Out of the remaining 88 patients, 17 (19.3%) patients developed hypotension after induction. The dIVC max , dIVC min and CI were comparable between patients who developed and who did not develop hypotension. The area under curve of ROC for CI, dIVC max and dIVC min was 0.51, 0.55 and 0.52, respectively, with optimum cut-off value of 0.46, 1.42 and 0.73, respectively. Conclusion: Ultrasound-derived IVC parameters demonstrate poor diagnostic accuracy for prediction of hypotension after induction in healthy adult patients.

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Section: Introductionmentioning

confidence: 99%

Prediction of post-induction hypotension in young adults using ultrasound-derived inferior vena cava parameters: An observational study

Mohammed¹,

Syal²,

Bhatia³

et al. 2021

Indian Journal of Anaesthesia

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“…The amount of mephentermine used to treat hypotension was significantly higher in patients with IVC-CI >50% with a p=0.026. A study by Ayyanagouda et al [14] demonstrated that the IVC-guided fluid optimization using USG before spinal anesthesia leads to a 40% reduction in the incidence of SIH as well as requirement of vasopressor during spinal anesthesia.…”

Section: Discussionmentioning

confidence: 99%

“…Pre-operative IVC-CI can predict hypotension after the induction of general anesthesia with high specificity [5]. In a randomized trial, IVC parameters guided fluid therapy before spinal anesthesia was found to produce a significant reduction of SIH [14]. To date, the predictive value of ultrasound-guided IVC examination remains inconclusive [15,16].…”

Section: Introductionmentioning

confidence: 99%

Preoperative Ultrasound-Guided Inferior Vena Cava Collapsibility Index as a Guide to Predict Hypotension Following Spinal Anesthesia

Krishnan,

KS,

2023

Asian J Pharm Clin Res

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Objective: Post-spinal hypotension is a commonly encountered complication following spinal anesthesia. However, there is a dearth of a concrete tool to predict spinal-induced hypotension (SIH) and differentiate the cohort of patients requiring fluid boluses versus vasopressors to correct it. Thus, we aimed to determine the prognostic efficacy of ultrasonographic assessment of inferior vena caval collapsibility index (IVC-CI) to predict hypotension following spinal anesthesia and compare the requirements of crystalloids and Mephentermine among patients with IVC-Collapsibility Index >50% and <50%. Methods: This observational study was conducted in the Department of Anesthesiology, Government Medical College, Kottayam. Preoperative IVC Ultrasonography was performed in 74 patients of ASA Grade 1–2 scheduled for elective surgery under spinal anesthesia and their IVC-CI was determined. Spinal anesthesia procedure protocol was standardized. Mean arterial pressure, intravenous fluids, and mephentermine requirements were documented in both IVC-CI groups. Results: There was no significant difference in the demographics or pre-operative vital signs between the two groups. Significant hypotension was seen in 51.4% of patients. 97% of patients with IVC-CI>50% had significant hypotension, p=0.000. IVCCI>50% is 97.2% specific and 84.2% sensitive in predicting SIH with a positive predictive value of 96.97% and negative predictive value of 85.37%. Significantly, high requirement of intravenous fluids and mephentermine was noted among IVC-CI>50% group, p=0.000 and 0.026, respectively. Conclusion: USG-guided IVC-CI is an easy to perform, non-invasive, time-efficient, and readily available technique to assess fluid responsiveness. Patients with IVC-CI>50% are more likely to develop SIH. Furthermore, the requirement of vasopressors and IV fluids increases with IVC-CI>50%. USG-guided IVC-CI is a reliable predictor of SIH.

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“…Gastric ultrasound for preoperative assessment of gastric volume, ultrasound of the spine for spinal and epidural blocks, inferior vena cava ultrasound for intravascular volume assessment and lung ultrasound for those on mechanical ventilation are now a hot topic of researchers and are being increasingly implemented in the clinical practice. [ 14 15 16 17 ] This issue of the IJA with four original articles on studies wherein ultrasound has been used to guide the anaesthesiologist, supports this statement emphatically. In one of these articles, real-time ultrasound-guided spinal anaesthesia has been compared with preprocedural ultrasound- guided spinal anaesthesia in obese patients.…”

Section: The Speciality and ‘Engineering And Technology’—a Strong Continuum Of Partnershipmentioning

confidence: 91%

Technology, engineering and innovations- Power buffers in the COVID driveline.....

Mehdiratta¹,

Bajwa

2021

Indian Journal of Anaesthesia

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Role of ultrasonographic inferior venacaval assessment in averting spinal anaesthesia-induced hypotension for hernia and hydrocele surgeries—A prospective randomised controlled study

Cited by 14 publications

References 19 publications

Prediction of post-induction hypotension in young adults using ultrasound-derived inferior vena cava parameters: An observational study

Prediction of post-induction hypotension in young adults using ultrasound-derived inferior vena cava parameters: An observational study

Preoperative Ultrasound-Guided Inferior Vena Cava Collapsibility Index as a Guide to Predict Hypotension Following Spinal Anesthesia

Technology, engineering and innovations- Power buffers in the COVID driveline.....

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