Pre-anaesthetic ultrasonographic assessment of neck vessels as predictors of spinal anaesthesia induced hypotension in the elderly: A prospective observational study

Abstract

ABSTRACT Background Increased age has been linked to the development of spinal anaesthesia induced hypotension (SAIH) and increased the risk of perioperative complications. The internal jugular vein collapsibility index (IJV-CI), rates of change in IJV diameter (ΔIJV-D) and IJV area (ΔIJV-A) in the supine and Trendelenburg positions, and carotid intima-media thickness (CIMT) were evaluated as predictors of SAIH in the senior population. Materials and methods This prospective Cohort was conducted at the Cairo University Hospitals. Seventy-one patients scheduled for elective procedures under spinal anaesthesia of ASA I–III, over 60 years and BMI less than 30 kg/m2. The right IJV was assessed ultrasonographically in supine and Trendelenburg postures, as well as CIMT. The primary outcome was the IJV- CI as predictor of SAIH while ΔIJV-D and ΔIJV-A with posture and CIMT in prediction of SAIH were assigned as secondary outcomes. Results SAIH was shown in forty-seven (66.2%) of patients. IJV-CI, ΔIJV-A and ΔIJV-D increased significantly in Hypotensive group (median 38.09, IQR (23.61–50), 0.393 (0.2–0.52) and 0.213 (0.12–0.34) respectively) in comparison to Non-hypotensive group (26.05 (10.32–34.08), 0.167 (0.03–0.48) and 0.074 (0.02–0.29) respectively) (p-value <0.05). IJV-CI showed AUROC of 0.699 and 95% CI of 0.578–0.802 (p-value = 0.002) with cut-off value ≥0.34.4, 61.70% sensitivity, 79.17% specificity, 85.3% PPV and 51.4% NPV. Conclusions Preanesthetic IJV-CI and ΔIJV-D from the supine to the Trendelenburg position were moderate predictors of SAIH. Results suggested that IJV-CI is > 34.4% and a ΔIJV-D is of ≥ 0.11 to be the threshold levels, while CMIT could not predict SAIH.