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Ultrasound measurement of inferior vena cava collapse predicts propofol-induced hypotension

Published:March 29, 2016DOI:https://doi.org/10.1016/j.ajem.2016.03.058

      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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      References

        • Smischney N.J.
        • Beach M.L.
        • Loftus R.W.
        • Dodds T.M.
        • Koff M.D.
        Ketamine/propofol admixture (ketofol) is associated with improved hemodynamics as an induction agent: a randomized, controlled trial.
        J Trauma Acute Care Surg. 2012; 73: 94-101
        • Reich D.L.
        • Hossain S.
        • Krol M.
        • Baez B.
        • Patel P.
        • Bernstein A.
        • et al.
        Predictors of hypotension after induction of general anesthesia.
        Anesth Analg. 2005; 101 ([table of contents]): 622-628
        • Jones A.E.
        • Yiannibas V.
        • Johnson C.
        • Kline J.A.
        Emergency department hypotension predicts sudden unexpected in-hospital mortality: a prospective cohort study.
        Chest. 2006; 130: 941-946
        • Blehar D.J.
        • Resop D.
        • Chin B.
        • Dayno M.
        • Gaspari R.
        Inferior Vena cava displacement during respirophasic ultrasound imaging.
        Crit Ultrasound J. 2012; 4: 18
        • Nagdev A.D.
        • Merchant R.C.
        • Tirado-Gonzalez A.
        • Sisson C.A.
        • Murphy M.C.
        Emergency department bedside ultrasonographic measurement of the caval index for noninvasive determination of low central venous pressure.
        Ann Emerg Med. 2010; 55: 290-295
        • Kasaba T.
        • Yamaga M.
        • Yoshimura Y.
        • Takasaki M.
        Ephedrine, dopamine, or dobutamine to treat hypotension with propofol during epidural anesthesia.
        Can J Anesth. 2000; : 237-241
        • Muzi M.
        • Berens R.A.
        • Ebert T.J.
        • Kampine J.P.
        Venodilation Contributes to Propofol-Media ted hypotension in Humans.
        Anesth Analg. 1992; 74: 877-883
        • el-Beheiry H.
        • Kim J.
        • Milne B.
        • Seegobin R.
        Prophylaxis against the systemic hypotension induced by propofol during rapid-sequence intubation.
        Can J Anaesth. 1995; 42: 875-878
        • Agarwal A.
        • Sharma K.
        • Parashar S.
        • Sharma A.
        • Meena M.
        Prevention of hypotension during propofol induction: a comparison of preloading with ringer lactate and intravenous ephedrine.
        J Evol Med Dent Sci. 2013; 2: 6640-6650
        • Stawicki S.P.A.
        • Adkins E.J.
        • Eiferman D.S.
        • Evans D.C.
        • Ali N.A.
        • Njoku C.
        • et al.
        Prospective evaluation of intravascular volume status in critically ill patients: does inferior vena cava collapsibility correlate with central venous pressure?.
        J Trauma Acute Care Surg. 2014; 76 ([discussion 963–4]): 956-963