Association of infraclavicular axillary vein diameter and collapsibility index with general anesthesia-induced hypotension in elderly patients undergoing gastrointestinal surgery: an observational study
Abstract Background The collapse index of inferior Vena Cava (IVC) and its diameter are important predictive tools for fluid responsiveness in patients, especially critically ones. The collapsibility of infraclavicular axillary vein (AXV) can be used as an alternative to the collapsibility of IVC (I...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2023-10-01
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| Series: | BMC Anesthesiology |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12871-023-02303-w |
| _version_ | 1797451714532474880 |
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| author | Huijuan Chen Xianlong Zhang Lei Wang Cuijuan Zheng Shenquan Cai Wei Cheng |
| author_facet | Huijuan Chen Xianlong Zhang Lei Wang Cuijuan Zheng Shenquan Cai Wei Cheng |
| author_sort | Huijuan Chen |
| collection | DOAJ |
| description | Abstract Background The collapse index of inferior Vena Cava (IVC) and its diameter are important predictive tools for fluid responsiveness in patients, especially critically ones. The collapsibility of infraclavicular axillary vein (AXV) can be used as an alternative to the collapsibility of IVC (IVC-CI) to assess the patient’s blood volume. Methods A total of 188 elderly patients aged between 65 and 85 years were recruited for gastrointestinal surgery under general anesthesia. Ultrasound measurements AXV and IVC were performed before induction of general anesthesia. Patients were grouped in accordance to the hypotension after induction. ROC curves were used to analyze the predictive value of ultrasound measurements of AXV and IVC for hypotension after induction of anesthesia. Pearson linear correlation was used to assess the correlation of ultrasound measurements and decrease in mean arterial blood pressure (MAP). Results The maximum diameter of AXV(dAXVmax) and the maximum diameter of IVC (dIVCmax) were not related to the percentage decrease in MAP; the collapsibility of AXV (AXV-CI) and IVC-CI were positively correlated with MAP changes (correlation coefficients:0.475, 0.577, respectively, p < 0.001). The areas under the curve (AUC) was 0.824 (0.759–0.889) for AXV-CI, and 0.874 (0.820–0.928) for IVC-CI. The optimal threshold for AXV-CI was 31.25% (sensitivity 71.7%, specificity 90.1%), while for IVC-CI was 36.60% (sensitivity 85.9%, specificity 79.0%). Hypotension and down-regulation of MAP during induction can be accurately predicted by AXV-Cl after correction for confounding variables. Conclusion Infraclavicular axillary vein diameter has no significant correlation with postanesthesia hypotension, whereas AXV-CI may predict postanesthesia hypotension during gastrointestinal surgery of the elderly. Trial registration This study was registered in the Clinical Trial Registry of China on 05/06/2022 (ChiCTR2200060596). |
| first_indexed | 2024-03-09T14:58:29Z |
| format | Article |
| id | doaj.art-d6c2f9e239e048fdb83ad872932cd11d |
| institution | Directory Open Access Journal |
| issn | 1471-2253 |
| language | English |
| last_indexed | 2024-03-09T14:58:29Z |
| publishDate | 2023-10-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Anesthesiology |
| spelling | doaj.art-d6c2f9e239e048fdb83ad872932cd11d2023-11-26T14:03:20ZengBMCBMC Anesthesiology1471-22532023-10-012311810.1186/s12871-023-02303-wAssociation of infraclavicular axillary vein diameter and collapsibility index with general anesthesia-induced hypotension in elderly patients undergoing gastrointestinal surgery: an observational studyHuijuan Chen0Xianlong Zhang1Lei Wang2Cuijuan Zheng3Shenquan Cai4Wei Cheng5Department of Anesthesiology, Affiliated Huaian No.1 Hospital of Nanjing Medical UniversityDepartment of Anesthesiology, Affiliated Huaian No.1 Hospital of Nanjing Medical UniversityDepartment of Anesthesiology, Affiliated Huaian No.1 Hospital of Nanjing Medical UniversityDepartment of Anesthesiology, Affiliated Huaian No.1 Hospital of Nanjing Medical UniversityDepartment of Anesthesiology, Affiliated Jinling Hospital, Medical School, Nanjing UniversityDepartment of Anesthesiology, Affiliated Huaian No.1 Hospital of Nanjing Medical UniversityAbstract Background The collapse index of inferior Vena Cava (IVC) and its diameter are important predictive tools for fluid responsiveness in patients, especially critically ones. The collapsibility of infraclavicular axillary vein (AXV) can be used as an alternative to the collapsibility of IVC (IVC-CI) to assess the patient’s blood volume. Methods A total of 188 elderly patients aged between 65 and 85 years were recruited for gastrointestinal surgery under general anesthesia. Ultrasound measurements AXV and IVC were performed before induction of general anesthesia. Patients were grouped in accordance to the hypotension after induction. ROC curves were used to analyze the predictive value of ultrasound measurements of AXV and IVC for hypotension after induction of anesthesia. Pearson linear correlation was used to assess the correlation of ultrasound measurements and decrease in mean arterial blood pressure (MAP). Results The maximum diameter of AXV(dAXVmax) and the maximum diameter of IVC (dIVCmax) were not related to the percentage decrease in MAP; the collapsibility of AXV (AXV-CI) and IVC-CI were positively correlated with MAP changes (correlation coefficients:0.475, 0.577, respectively, p < 0.001). The areas under the curve (AUC) was 0.824 (0.759–0.889) for AXV-CI, and 0.874 (0.820–0.928) for IVC-CI. The optimal threshold for AXV-CI was 31.25% (sensitivity 71.7%, specificity 90.1%), while for IVC-CI was 36.60% (sensitivity 85.9%, specificity 79.0%). Hypotension and down-regulation of MAP during induction can be accurately predicted by AXV-Cl after correction for confounding variables. Conclusion Infraclavicular axillary vein diameter has no significant correlation with postanesthesia hypotension, whereas AXV-CI may predict postanesthesia hypotension during gastrointestinal surgery of the elderly. Trial registration This study was registered in the Clinical Trial Registry of China on 05/06/2022 (ChiCTR2200060596).https://doi.org/10.1186/s12871-023-02303-wAnesthesiaHypotensionInfraclavicular axillary veinInferior vena cavaEchocardiography |
| spellingShingle | Huijuan Chen Xianlong Zhang Lei Wang Cuijuan Zheng Shenquan Cai Wei Cheng Association of infraclavicular axillary vein diameter and collapsibility index with general anesthesia-induced hypotension in elderly patients undergoing gastrointestinal surgery: an observational study BMC Anesthesiology Anesthesia Hypotension Infraclavicular axillary vein Inferior vena cava Echocardiography |
| title | Association of infraclavicular axillary vein diameter and collapsibility index with general anesthesia-induced hypotension in elderly patients undergoing gastrointestinal surgery: an observational study |
| title_full | Association of infraclavicular axillary vein diameter and collapsibility index with general anesthesia-induced hypotension in elderly patients undergoing gastrointestinal surgery: an observational study |
| title_fullStr | Association of infraclavicular axillary vein diameter and collapsibility index with general anesthesia-induced hypotension in elderly patients undergoing gastrointestinal surgery: an observational study |
| title_full_unstemmed | Association of infraclavicular axillary vein diameter and collapsibility index with general anesthesia-induced hypotension in elderly patients undergoing gastrointestinal surgery: an observational study |
| title_short | Association of infraclavicular axillary vein diameter and collapsibility index with general anesthesia-induced hypotension in elderly patients undergoing gastrointestinal surgery: an observational study |
| title_sort | association of infraclavicular axillary vein diameter and collapsibility index with general anesthesia induced hypotension in elderly patients undergoing gastrointestinal surgery an observational study |
| topic | Anesthesia Hypotension Infraclavicular axillary vein Inferior vena cava Echocardiography |
| url | https://doi.org/10.1186/s12871-023-02303-w |
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