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Preoperative inferior vena cava ultrasonography can predict post-induction hypotension in patients undergoing gastrointestinal surgery

Yıl 2019, Cilt: 44 Sayı: 4, 1243 - 1249, 29.12.2019
https://doi.org/10.17826/cumj.512617

Öz

Purpose: In this study we aimed to evaluate effectiveness of preoperative IVC ultrasonography in predicting hypotension which develops following anesthesia induction, and in determining hypovolemia occurring in patients undergoing bowel preparation as secondary outcomes. 

Materials and Methods: The study included patients with American Society of Anesthesiologists physical status classification (ASA) I-II, aged between 18 and 65 years who were scheduled for gastrointestinal operation under general anesthesia. Fourty-two of the 84 patients included underwent bowel preparation. Patients’ maximum diameter of inferior vena cava (dIVCmax) and minimum diameter of inferior vena cava (dIVCmin), inferior vena cava collapsibility index (IVC-CI) and preinduction basal mean arterial pressure (MAP) was measured. 

Results: Thirty-nine (46.4%) of the 84 patients developed hypotension after general anesthesia induction. Cut-off for dIVCmax was found as 15.750 mm with ROC analysis. Specificity and sensitivity for the cut-off value of 15.750 mm were calculated as 55.6% and 71.8%, respectively. Cut-off for IVC-CI was found as 32.746 % with ROC analysis. Specificity and sensitivity for the cut-off value of 32.746 % mm were calculated as 83.3% and 74.4%, respectively. 

Conclusion: According to our data, IVC ultrasonography may be helpful in prediction of preoperative hypovolemia in patients. IVC-CI was higher and dIVCmax was lower and the incidence of hypotension was higher in patients who underwent bowel preparation compared to the patient who did not undergo. 


Kaynakça

  • 1. Zmora O, Pikarsky AJ, Wexner SD. Bowel preparationaration for colorectal surgery. Dis Colon Rectum. 2001;44 (10):1537-1549.
  • 2. Holte K, Nielsen KG, Madsen JL, Kehlet H. Physiologic effects of bowel preparationaration. Dis Colon Rectum. 2004;47 (8):1397-1402.
  • 3. Reich DL, Hossain S, Krol M, Baez B, Patel P, Bernstein A, et al. Predictors of hypotension after induction of general anesthesia. Anesth Analg 2005;101 (3):622–628
  • 4. Zhang J, Critchley LA. Inferior Vena Cava Ultrasonography before General Anesthesia Can Predict Hypotension after Induction Anesthesiology. 2016;124: (3) 580-589.
  • 5. Butterworth JF, Mackey DC, Wasnick JD. Morgan & Mikhail’s Clinical Anesthesiology, 5th ed. New York: Lange Medical Books/ McGraw-Hill; 2013
  • 6. Marik PE, Baram M, Vahid B. Does central venous pressure predict fluid responsiveness? A systematic review of the literature and the tale of seven mares. Chest. 2008;134 (1):172-178.
  • 7. Renner J, Scholz J, Bein B. Monitoring fluid therapy. Best Pract Res Clin Anaesthesiol. 2009;23 (2):159-171.
  • 8. Thiele RH, Bartels K, Gan TJ. Inter-device differences in monitoring for goal-directed fluid therapy. Can J Anaesth. 2015;62 (2):169-181.
  • 9. Dipti A, Soucy Z, Surana A, Chandra S. Role of inferior vena cava diameter in assessment of volume status: a meta-analysis. Am J Emerg Med 2012;30 (8):1414–1419.
  • 10. De Vecchis R, Baldi C. Inferior Vena Cava and Hemodynamic Congestion. Res Cardiovasc Med. 2015;4 (3):28913.
  • 11. Rudski LG, Lai WW, Afilalo J, Hua L, Handschumacher MD, Chandrasekaran K, et al. Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography. J Am Soc Echocardiogr. 2010;23 (7):685-713.
  • 12. Seif D, Mailhot T, Perera P, Mandavia D. Caval sonography in shock: A noninvasive method for evaluating intravascular volume in critically ill patients. J Ultrasound Med 2012; 31 (12):1885–1890
  • 13. Nagdev AD, Merchant RC, Tirado-Gonzalez A, Sisson CA, Murphy MC. Emergency department bedside ultrasonographic measurement of the caval index for noninvasive determination of low central venous pressure. Ann Emerg Med. 2010;55 (3):290-295.
  • 14. Muller L, Bobbia X, Toumi M, Louart G, Molinari N, Ragonnet B, et.al Respiratory variations of inferior vena cava diameter to predict fluid responsiveness in spontaneously breathing patients with acute circulatory failure: need for a cautious use.Crit Care. 2012;16 (5):188.
  • 15. Airapetian N, Maizel J, Alyamani O, Mahjoub Y, Lorne E, Levrard M, et al. Does inferior vena cava respiratory variability predict fluid responsiveness in spontaneously breathing patients? Crit Care. 2015;19 (13):400.
  • 16. Zhang J, Critchley LA. Inferior Vena Cava Ultrasonography before General Anesthesia Can Predict Hypotension after Induction Anesthesiology. 2016;124 (3):580-589.
  • 17. Brienza N, Giglio MT, Marucci M, Fiore T. Does perioperative hemodynamic optimization protect renal function in surgical patients? a meta-analytic study. Crit Care Med. 2009;37:2079-2090.
  • 18. Bijker J, van Klei W, Kappen T, van Wolfswinkel L, Moons K, Kalkman C. Incidence of intraoperative hypotension as a function of the chosen definition. Anesthesiology. 2007;107 (6):213-220.
  • 19. Walsh M, Devereaux PJ, Garg AX, Kurz A, Turan A, Rodseth RN, et al. Sessler DI. Relationship between intraoperative mean arterial pressure and clinical outcomes after noncardiac surgery: Toward an empirical definition of hypotension. Anesthesiology. 2013;119 (3):507-515
  • 20. Claeys MA, Gepts E, Camu F. Haemodynamic changes during anaesthesia induced and maintained with propofol. Br J Anaesth. 1988 ;60 (1):3-9
  • 21. Bano F, Zafar S, Sabbar S, Aftab S, Haider S, Sultan ST. Intravenous ketamine attenuates injection pain and arterial pressure changes during the induction of anesthesia with propofol: A comparison with lidocaine. J Coll Physicians Surg Pak. 2007;17 (7):390-393.
  • 22. Larsen R, Rathgeber J, Bagdahn A, Lange H, Rieke H. Effects of propofol on cardiovascular dynamics and coronary blood flow in geriatric patients. A comparison with etomidate. Anaesthesia. 1988;43 (8):25-31.
  • 23. Jacob M, Chappell D, Conzen P, Finsterer U, Rehm M. Blood volume is normal after pre-operative overnight fasting. Acta Anaesthesiol Scand. 2008;52 (4):522-529.

Preoperatif vena cava inferior ultrasonografisi gastrointestinal cerrahi altindaki hastalarda indüksiyon sonrası hipotansiyonu tahmin edebilir

Yıl 2019, Cilt: 44 Sayı: 4, 1243 - 1249, 29.12.2019
https://doi.org/10.17826/cumj.512617

Öz

Amaç: Bu çalışmada, preoperatif inferior vena kava ultrasonografisinin anestezi indüksiyonu sonrası gelişen hipotansiyonu öngörmede etkinliğini ve ikincil olarak bağırsak hazırlığı yapılan hastalarda oluşan hipovolemiyi tesbitini değerlendirmeyi amaçladık.

Gereç ve Yöntem: Genel anestezi altında gastrointestinal cerrahi operasyon geçirecek 18-65 yaş arası American Society of Anaesthesiologists physical status classification (ASA) I-II hastalar dahil edildi. Çalışmaya dahil edilen 84 olgunun 42’sine barsak hazırlığı yapılmıştı. Hastaların inferior vena kava maksimun çapı (dİVK maks) ve inferior vena kava minimum çapı (dİVK min), inferior vena kava kollabsibilite indeksi (İVK-Kİ, indüksiyon öncesi bazal ortalama arter basıncı (OAB)  ve İndüksiyon sonrası cerrahi insizyona kadar hastaların kan basıncı ölçümleri ölçüldü. 

Bulgular: Çalışmaya dahil edilen 84 hastanın 39’unda (% 46.4) genel anestezi indüksiyonundan sonra hipotansiyon gelişti. ROC eğrisi analizi ile dİVK maks için cut-off değeri 15.750 mm olarak bulundu. 15.750 mm cut-off değeri için spesifite ve sensitivite sırasıyla %55.6-%71.8 olarak bulundu. ROC eğrisi analizi ile İVK-Kİ için cut-off değeri 32.7460 olarak bulundu. 32.7460 cut-off değeri için spesifite ve sensitivite sırasıyla %83.3-%74.4 olarak bulundu. 

Sonuç: İnferior vena kava ultrasonografisi hastalarda preoperatif hipovolemiyi öngörmede faydalı olabilir. Verilerimize göre barsak hazırlığı yapılmayan hastalarla karşılaştırıldığında barsak hazırlığı yapılan hastalarda yüksek İVK-Kİ ve düşük dİVK maks değerleri ve yüksek hipotansiyon insidansı görülmüştür.


Kaynakça

  • 1. Zmora O, Pikarsky AJ, Wexner SD. Bowel preparationaration for colorectal surgery. Dis Colon Rectum. 2001;44 (10):1537-1549.
  • 2. Holte K, Nielsen KG, Madsen JL, Kehlet H. Physiologic effects of bowel preparationaration. Dis Colon Rectum. 2004;47 (8):1397-1402.
  • 3. Reich DL, Hossain S, Krol M, Baez B, Patel P, Bernstein A, et al. Predictors of hypotension after induction of general anesthesia. Anesth Analg 2005;101 (3):622–628
  • 4. Zhang J, Critchley LA. Inferior Vena Cava Ultrasonography before General Anesthesia Can Predict Hypotension after Induction Anesthesiology. 2016;124: (3) 580-589.
  • 5. Butterworth JF, Mackey DC, Wasnick JD. Morgan & Mikhail’s Clinical Anesthesiology, 5th ed. New York: Lange Medical Books/ McGraw-Hill; 2013
  • 6. Marik PE, Baram M, Vahid B. Does central venous pressure predict fluid responsiveness? A systematic review of the literature and the tale of seven mares. Chest. 2008;134 (1):172-178.
  • 7. Renner J, Scholz J, Bein B. Monitoring fluid therapy. Best Pract Res Clin Anaesthesiol. 2009;23 (2):159-171.
  • 8. Thiele RH, Bartels K, Gan TJ. Inter-device differences in monitoring for goal-directed fluid therapy. Can J Anaesth. 2015;62 (2):169-181.
  • 9. Dipti A, Soucy Z, Surana A, Chandra S. Role of inferior vena cava diameter in assessment of volume status: a meta-analysis. Am J Emerg Med 2012;30 (8):1414–1419.
  • 10. De Vecchis R, Baldi C. Inferior Vena Cava and Hemodynamic Congestion. Res Cardiovasc Med. 2015;4 (3):28913.
  • 11. Rudski LG, Lai WW, Afilalo J, Hua L, Handschumacher MD, Chandrasekaran K, et al. Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography. J Am Soc Echocardiogr. 2010;23 (7):685-713.
  • 12. Seif D, Mailhot T, Perera P, Mandavia D. Caval sonography in shock: A noninvasive method for evaluating intravascular volume in critically ill patients. J Ultrasound Med 2012; 31 (12):1885–1890
  • 13. Nagdev AD, Merchant RC, Tirado-Gonzalez A, Sisson CA, Murphy MC. Emergency department bedside ultrasonographic measurement of the caval index for noninvasive determination of low central venous pressure. Ann Emerg Med. 2010;55 (3):290-295.
  • 14. Muller L, Bobbia X, Toumi M, Louart G, Molinari N, Ragonnet B, et.al Respiratory variations of inferior vena cava diameter to predict fluid responsiveness in spontaneously breathing patients with acute circulatory failure: need for a cautious use.Crit Care. 2012;16 (5):188.
  • 15. Airapetian N, Maizel J, Alyamani O, Mahjoub Y, Lorne E, Levrard M, et al. Does inferior vena cava respiratory variability predict fluid responsiveness in spontaneously breathing patients? Crit Care. 2015;19 (13):400.
  • 16. Zhang J, Critchley LA. Inferior Vena Cava Ultrasonography before General Anesthesia Can Predict Hypotension after Induction Anesthesiology. 2016;124 (3):580-589.
  • 17. Brienza N, Giglio MT, Marucci M, Fiore T. Does perioperative hemodynamic optimization protect renal function in surgical patients? a meta-analytic study. Crit Care Med. 2009;37:2079-2090.
  • 18. Bijker J, van Klei W, Kappen T, van Wolfswinkel L, Moons K, Kalkman C. Incidence of intraoperative hypotension as a function of the chosen definition. Anesthesiology. 2007;107 (6):213-220.
  • 19. Walsh M, Devereaux PJ, Garg AX, Kurz A, Turan A, Rodseth RN, et al. Sessler DI. Relationship between intraoperative mean arterial pressure and clinical outcomes after noncardiac surgery: Toward an empirical definition of hypotension. Anesthesiology. 2013;119 (3):507-515
  • 20. Claeys MA, Gepts E, Camu F. Haemodynamic changes during anaesthesia induced and maintained with propofol. Br J Anaesth. 1988 ;60 (1):3-9
  • 21. Bano F, Zafar S, Sabbar S, Aftab S, Haider S, Sultan ST. Intravenous ketamine attenuates injection pain and arterial pressure changes during the induction of anesthesia with propofol: A comparison with lidocaine. J Coll Physicians Surg Pak. 2007;17 (7):390-393.
  • 22. Larsen R, Rathgeber J, Bagdahn A, Lange H, Rieke H. Effects of propofol on cardiovascular dynamics and coronary blood flow in geriatric patients. A comparison with etomidate. Anaesthesia. 1988;43 (8):25-31.
  • 23. Jacob M, Chappell D, Conzen P, Finsterer U, Rehm M. Blood volume is normal after pre-operative overnight fasting. Acta Anaesthesiol Scand. 2008;52 (4):522-529.
Toplam 23 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Klinik Tıp Bilimleri, Gastroenteroloji ve Hepatoloji
Bölüm Araştırma
Yazarlar

Şevki Sarı Bu kişi benim 0000-0002-4934-9399

Şule Arıcan 0000-0002-8634-1150

Ahmet Topal 0000-0001-9832-9741

Gülçin Hacıbeyoğlu 0000-0002-9438-3414

Sema Tuncer Uzun 0000-0002-6205-1706

Yayımlanma Tarihi 29 Aralık 2019
Kabul Tarihi 24 Mart 2019
Yayımlandığı Sayı Yıl 2019 Cilt: 44 Sayı: 4

Kaynak Göster

MLA Sarı, Şevki vd. “Preoperative Inferior Vena Cava Ultrasonography Can Predict Post-Induction Hypotension in Patients Undergoing Gastrointestinal Surgery”. Cukurova Medical Journal, c. 44, sy. 4, 2019, ss. 1243-9, doi:10.17826/cumj.512617.