Ultrasound guided assessment of internal jugular vein parameters for prediction of postinduction hypotension in cirrhotic patients
Abstract
Background & objective: Liver cirrhosis has been associated with an elevated risk of perioperative complications and the development of post-induction hypotension (PIH). The purpose of this research was to determine how well changes in the internal jugular vein) IJV (diameter and area can predict post-induction hypotension in cirrhotic patients.
Methodology: A prospective study was conducted in 96 cirrhotic patients, undergoing general anesthesia for surgery, at Department of Anesthesia, Menoufia University hospitals, from October 2023 to September 2024. IJV diameter, area, collapsibility index in supine and Trendelenburg positions and IJV change rate measurements were recorded. A decrease in mean arterial pressure (MAP) by more than 20% of the baseline was defined as ‘hypotension’. A persistent hypotension for ≥ 2 min was defined as ‘prolonged hypotension’. If MAP was reduced by over 40% from the baseline value, it was considered as ‘severe hypotension’.
Results: Hypotension occured in 68% of the participants studied. There was no statistically significant difference between hypotensive and non-hypotensive groups regarding age, sex and baseline mean blood pressure. Δ IJV maximum diameter, ΔIJV minimum diameter, ΔIJV -A, ΔIJV-CI with cut-off point (≥ 0.14, ≤ 0.10, ≥ 0.22, ≥ 0.21 respectively) and sensitivity and specificity of (81% and 97%/ 67% and 77% / 100% and 90% / 78% and 90% respectively) in prediction of hypotension
Conclusion: The ultrasound guided measurement of IJV parameters demonstrated a good diagnostic accuracy during both the supine and Trendelenburg position for predicting postinduction hypotensive response especially, the change rate of IJV area.
Keywords: Internal Jugular Vein; Ultrasonographic Measurement; Hypotension; General Anesthesia; Induction
Citation: Afify NA, Fathi YE, Ghanem MA, Mowafy NI, Bahgat NM. Anaesth. pain intensive care; 2025;29(2):270-277. DOI: 10.35975/apic.v29i2.2715
Received: May 09, 2024; Reviewed: October 26, 2024; Accepted: January 01, 2025
