Abstract
Study Objectives
Hypotension is a common side effect of propofol, but there are no reliable methods
to determine which patients are at risk for significant propofol-induced hypotension
(PIH). Ultrasound has been used to estimate volume status by visualization of inferior
vena cava (IVC) collapse. This study explores whether IVC assessment by ultrasound
can assist in predicting which patients may experience significant hypotension.
Methods
This was a prospective observational study conducted in the operating suite of an
urban community hospital. A convenience sample of consenting adults planned to receive
propofol for induction of anesthesia during scheduled surgical procedures were enrolled.
Bedside ultrasound was used to measure maximum (IVCmax) and minimum (IVCmin) IVC diameters.
IVC-CI was calculated as [(IVCmax-IVCmin)/IVCmax × 100%]. The primary outcome was
significant hypotension defined as systolic blood pressure (BP) below 90 mmHg and/or administration of a vasopressor to increase BP during surgery.
Results
The study sample comprised 40 patients who met inclusion criteria. Mean age was 55 years, (95%CI, 49–60) with 53% female. 55% of patients had significant hypotension
after propofol administration. 76% of patients with IVC-CI ≥ 50% had significant hypotension compared to 39% with IVC-CI< 50%, P = .02. IVC-CI ≥ 50% had a specificity of 77.27% (95%CI, 64.29%–90.26%) and sensitivity of 66.67% (95%CI,
52.06%–81.28%) in predicting PIH. The odds ratio for PIH in patients with IVC-CI ≥ 50% was 6.9 (95%CI, 1.7–27.5).
Conclusion
Patients with IVC-CI ≥ 50% were more likely to develop significant hypotension from propofol. IVC ultrasound
may be a useful tool to predict which patients are at increased risk for PIH.
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Article Info
Publication History
Published online: March 29, 2016
Accepted:
March 24,
2016
Received in revised form:
March 23,
2016
Received:
October 30,
2015
Footnotes
☆Funding Sources/Disclosures: None.
☆☆Prior Presentations: Presented as preliminary results at the American College of Emergency Physicians Annual Conference, October 2014, Chicago, IL.
Identification
Copyright
© 2016 Elsevier Inc. All rights reserved.
