Effect of subclavian vein diameter combined with perioperative fluid therapy on preventing post-induction hypotension in patients with ASA status I or II
Abstract Background Perioperative hypotension is frequently observed following the initiation of general anesthesia administration, often associated with adverse outcomes. This study assessed the effect of subclavian vein (SCV) diameter combined with perioperative fluid therapy on preventing post-in...
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| Format: | Article |
| Language: | English |
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BMC
2024-04-01
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| Series: | BMC Anesthesiology |
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| Online Access: | https://doi.org/10.1186/s12871-024-02514-9 |
| _version_ | 1797209146226900992 |
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| author | Bin Wang Kangli Hui Jingwei Xiong Chongya Yang Xinyu Cao Guangli Zhu Yang Ang Manlin Duan |
| author_facet | Bin Wang Kangli Hui Jingwei Xiong Chongya Yang Xinyu Cao Guangli Zhu Yang Ang Manlin Duan |
| author_sort | Bin Wang |
| collection | DOAJ |
| description | Abstract Background Perioperative hypotension is frequently observed following the initiation of general anesthesia administration, often associated with adverse outcomes. This study assessed the effect of subclavian vein (SCV) diameter combined with perioperative fluid therapy on preventing post-induction hypotension (PIH) in patients with lower ASA status. Methods This two-part study included patients aged 18 to 65 years, classified as ASA physical status I or II, and scheduled for elective surgery. The first part (Part I) included 146 adult patients, where maximum SCV diameter (dSCVmax), minimum SCV diameter (dSCVmin), SCV collapsibility index (SCVCI) and SCV variability (SCVvariability) assessed using ultrasound. PIH was determined by reduction in mean arterial pressure (MAP) exceeding 30% from baseline measurement or any instance of MAP < falling below 65 mmHg for ≥ a duration of at least 1 min during the period from induction to 10 min after intubation. Receiver Operating Characteristic (ROC) curve analysis was employed to determine the predictive values of subclavian vein diameter and other relevant parameters. The second part comprised 124 adult patients, where patients with SCV diameter above the optimal cutoff value, as determined in Part I study, received 6 ml/kg of colloid solution within 20 min before induction. The study evaluated the impact of subclavian vein diameter combined with perioperative fluid therapy by comparing the observed incidence of PIH after induction of anesthesia. Results The areas under the curves (with 95% confidence intervals) for SCVCI and SCVvariability were both 0.819 (0.744–0.893). The optimal cutoff values were determined to be 45.4% and 14.7% (with sensitivity of 76.1% and specificity of 86.7%), respectively. Logistic regression analysis, after adjusting for confounding factors, demonstrated that both SCVCI and SCVvariability were significant predictors of PIH. A threshold of 45.4% for SCVCI was chosen as the grouping criterion. The incidence of PIH in patients receiving fluid therapy was significantly lower in the SCVCI ≥ 45.4% group compared to the SCVCI < 45.4% group. Conclusions Both SCVCI and SCVvariability are noninvasive parameters capable of predicting PIH, and their combination with perioperative fluid therapy can reduce the incidence of PIH. |
| first_indexed | 2024-04-24T09:50:03Z |
| format | Article |
| id | doaj.art-899d56bc33fe436dbe03cf5701ee7f13 |
| institution | Directory Open Access Journal |
| issn | 1471-2253 |
| language | English |
| last_indexed | 2024-04-24T09:50:03Z |
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| spelling | doaj.art-899d56bc33fe436dbe03cf5701ee7f132024-04-14T11:27:23ZengBMCBMC Anesthesiology1471-22532024-04-012411910.1186/s12871-024-02514-9Effect of subclavian vein diameter combined with perioperative fluid therapy on preventing post-induction hypotension in patients with ASA status I or IIBin Wang0Kangli Hui1Jingwei Xiong2Chongya Yang3Xinyu Cao4Guangli Zhu5Yang Ang6Manlin Duan7Department of Anesthesiology, Jinling College affiliated to Nanjing Medical UniversityDepartment of Anesthesiology, Jinling College affiliated to Nanjing Medical UniversityDepartment of Anesthesiology, Jinling College affiliated to Nanjing Medical UniversityCollege of Anesthesiology, Xuzhou Medical UniversityCollege of Anesthesiology, Xuzhou Medical UniversityCollege of Anesthesiology, Xuzhou Medical UniversityDepartment of Anesthesiology, Affiliated Jinling Hospital, Medical School, Nanjing UniversityDepartment of Anesthesiology, Jinling College affiliated to Nanjing Medical UniversityAbstract Background Perioperative hypotension is frequently observed following the initiation of general anesthesia administration, often associated with adverse outcomes. This study assessed the effect of subclavian vein (SCV) diameter combined with perioperative fluid therapy on preventing post-induction hypotension (PIH) in patients with lower ASA status. Methods This two-part study included patients aged 18 to 65 years, classified as ASA physical status I or II, and scheduled for elective surgery. The first part (Part I) included 146 adult patients, where maximum SCV diameter (dSCVmax), minimum SCV diameter (dSCVmin), SCV collapsibility index (SCVCI) and SCV variability (SCVvariability) assessed using ultrasound. PIH was determined by reduction in mean arterial pressure (MAP) exceeding 30% from baseline measurement or any instance of MAP < falling below 65 mmHg for ≥ a duration of at least 1 min during the period from induction to 10 min after intubation. Receiver Operating Characteristic (ROC) curve analysis was employed to determine the predictive values of subclavian vein diameter and other relevant parameters. The second part comprised 124 adult patients, where patients with SCV diameter above the optimal cutoff value, as determined in Part I study, received 6 ml/kg of colloid solution within 20 min before induction. The study evaluated the impact of subclavian vein diameter combined with perioperative fluid therapy by comparing the observed incidence of PIH after induction of anesthesia. Results The areas under the curves (with 95% confidence intervals) for SCVCI and SCVvariability were both 0.819 (0.744–0.893). The optimal cutoff values were determined to be 45.4% and 14.7% (with sensitivity of 76.1% and specificity of 86.7%), respectively. Logistic regression analysis, after adjusting for confounding factors, demonstrated that both SCVCI and SCVvariability were significant predictors of PIH. A threshold of 45.4% for SCVCI was chosen as the grouping criterion. The incidence of PIH in patients receiving fluid therapy was significantly lower in the SCVCI ≥ 45.4% group compared to the SCVCI < 45.4% group. Conclusions Both SCVCI and SCVvariability are noninvasive parameters capable of predicting PIH, and their combination with perioperative fluid therapy can reduce the incidence of PIH.https://doi.org/10.1186/s12871-024-02514-9Induction of general anesthesiaPost-induction hypotensionSubclavian vein collapsibility indexSubclavian vein variabilityPerioperative fluid therapy |
| spellingShingle | Bin Wang Kangli Hui Jingwei Xiong Chongya Yang Xinyu Cao Guangli Zhu Yang Ang Manlin Duan Effect of subclavian vein diameter combined with perioperative fluid therapy on preventing post-induction hypotension in patients with ASA status I or II BMC Anesthesiology Induction of general anesthesia Post-induction hypotension Subclavian vein collapsibility index Subclavian vein variability Perioperative fluid therapy |
| title | Effect of subclavian vein diameter combined with perioperative fluid therapy on preventing post-induction hypotension in patients with ASA status I or II |
| title_full | Effect of subclavian vein diameter combined with perioperative fluid therapy on preventing post-induction hypotension in patients with ASA status I or II |
| title_fullStr | Effect of subclavian vein diameter combined with perioperative fluid therapy on preventing post-induction hypotension in patients with ASA status I or II |
| title_full_unstemmed | Effect of subclavian vein diameter combined with perioperative fluid therapy on preventing post-induction hypotension in patients with ASA status I or II |
| title_short | Effect of subclavian vein diameter combined with perioperative fluid therapy on preventing post-induction hypotension in patients with ASA status I or II |
| title_sort | effect of subclavian vein diameter combined with perioperative fluid therapy on preventing post induction hypotension in patients with asa status i or ii |
| topic | Induction of general anesthesia Post-induction hypotension Subclavian vein collapsibility index Subclavian vein variability Perioperative fluid therapy |
| url | https://doi.org/10.1186/s12871-024-02514-9 |
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