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

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.