Crtical Care and Shock Journal

Inferior vena cava collapsibility index pre-induction is superior to caval aortic index pre-induction in predicting hypotension after induction of general anaesthesia

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Objective: The study aims to compare the pre-induction inferior vena cava collapsibility index (IVC-CI) and caval aortic index (CAo-I) as hypotension after induction of general anaesthesia (GAIH) predictors.

Design: This is an analytic observational study.

Setting: This study was conducted in Dr. Saiful Anwar General Hospital.

Patients and participant: This study was conducted on thirty-six patients undergoing general anaesthesia.

Intervention: IVC-CI and CAo-I were measured before induction using ultrasound guide. Baseline blood pressure, mean arterial pressure (MAP), heart rate, maximum IVC diameter (dIVCmax), aortic diameter (dAo) were recorded before induction, then were repeated five minutes after induction. Patients received general anaesthesia induction using propofol 2 mg/kg. Analgesic using fentanyl 2 µg/kg and muscle relaxant using atracurium 0.5 mg/kg. Patients received preoxygenation of 100% oxygen for 3-5 minutes.

Result: MAP, heart rate, dIVCmax, dAo before and after induction were significantly different (p=0.000). Thirty patients (36.1%) experienced GAIH. There was no significant difference in age, gender, body mass index, physical status, and MAP pre-induction (p>0.05) between the hypotension and no-hypotension group, except for MAP induction (p=0.001). Pre-induction IVC-CI significantly correlated with hypotension (p=0.024; r=0.375), but not in CAo-I (p>0.05; r=-0.100). The receiver operating characteristic test showed that IVC-CI had higher sensitivity (69.57%), specificity (69.23%), and accuracy (69.44%) than CAo-I, with cut-off value greater than 62.70% (confident interval 95%).

Conclusion: Pre-induction IVC-CI is superior to CAo-I in predict hypotension after induction of general anaesthesia.

Wiwi Jaya, Ristiawan Muji Laksono, Alfons Octavian Sabandar, Arie Zainul Fatoni


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