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Pre-anesthetic ultrasonographic assessment of the internal jugular vein for prediction of hypotension during the induction of general anesthesia

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A Letter to the Editor to this article was published on 09 November 2019

Abstract

Purpose

Severe hypotension caused by anesthetic administration for anesthesia induction, which might cause ischemic stroke, myocardial injury, acute kidney injury and postoperative mortality, should be prevented. Anesthesiologists are familiar with ultrasound examination of the internal jugular vein (IJV). This study aimed to clarify whether ultrasonographic IJV evaluation just before induction could predict the occurrence of such hypotension.

Methods

Adult patients undergoing surgery under general anesthesia were enrolled after excluding patients with cardiovascular disease or ASA-PS ≥ III. Ultrasonographic IJV images were recorded in both the supine and 10° Trendelenburg positions immediately before induction. Using these images, IJV area (IJV-A), diameter and change rate with posture were measured. Hypotension during induction was defined as mean BP < 60 mmHg or > 30% decrease from baseline.

Results

Hypotension during induction was observed in 37 of 82 patients. IJV-A in the Trendelenburg position was 2.02 ± 0.86 and 1.72 ± 0.68 in the hypotensive and non-hypotensive groups, respectively (P = 0.08). Logistic regression analysis performed using age, use of calcium antagonists, angiotensin converting enzyme inhibitors/angiotensin receptor blockers, baseline mean BP and IJV-A in the Trendelenburg position as variables showed that IJV-A in the Trendelenburg position was an independent predictor of hypotension, with an adjusted odds ratio of 3.11 (95% CI 1.07–9.03, P = 0.04). Area under the curve was 0.595 (95% CI 0.469–0.722) for IJV-A in the Trendelenburg position.

Conclusion

IJV-A in the Trendelenburg position was an independent predictor of hypotension during induction. Further study is required to examine the diagnostic accuracy of IJV-A as a predictor for hypotension during induction.

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References

  1. Ebert TJ, Muzi M, Berens R, Goff D, Kampine JP. Sympathetic responses to induction of anesthesia in humans with propofol or etomidate. Anesthesiology. 1992;76:725–33.

    Article  CAS  Google Scholar 

  2. Lonjaret L, Lairez O, Minville V, Geeraerts T. Optimal perioperative management of arterial blood pressure. Integr Blood Press Control. 2014;7:49–59.

    Article  CAS  Google Scholar 

  3. Bijker JB, Persoon S, Peelen LM, Moons KG, Kalkman CJ, Kappelle LJ, van Klei WA. Intraoperative hypotension and perioperative ischemic stroke after general surgery: a nested case–control study. Anesthesiology. 2012;116:658–64.

    Article  Google Scholar 

  4. Walsh M, Devereaux PJ, Garg AX, Kurz A, Turan A, Rodseth RN, Cywinski J, Thabane L, Sessler DI. Relationship between intraoperative mean arterial pressure and clinical outcomes after noncardiac surgery: toward an empirical definition of hypotension. Anesthesiology. 2013;119:507–15.

    Article  Google Scholar 

  5. Sun LY, Wijeysundera DN, Tait GA, Beattie WS. Association of intraoperative hypotension with acute kidney injury after elective noncardiac surgery. Anesthesiology. 2015;123:515–23.

    Article  Google Scholar 

  6. Wesselink EM, Kappen TH, Torn HM, Slooter AJC, van Klei WA. Intraoperative hypotension and the risk of postoperative adverse outcomes: a systematic review. Br J Anaesth. 2018;121:706–21.

    Article  CAS  Google Scholar 

  7. Monk TG, Bronsert MR, Henderson WG, Mangione MP, Sum-Ping ST, Bentt DR, Nguyen JD, Richman JS, Meguid RA, Hammermeister KE. Association between intraoperative hypotension and hypertension and 30-day postoperative mortality in noncardiac surgery. Anesthesiology. 2015;123:307–19.

    Article  Google Scholar 

  8. Zhang J, Critchley LA. Inferior vena cava ultrasonography before general anesthesia can predict hypotension after induction. Anesthesiology. 2016;124:580–9.

    Article  CAS  Google Scholar 

  9. Juri T, Suehiro K, Tsujimoto S, Kuwata S, Mukai A, Tanaka K, Yamada T, Mori T, Nishikawa K. Pre-anesthetic stroke volume variation can predict cardiac output decrease and hypotension during induction of general anesthesia. J Clin Monit Comput. 2018;32:415–22.

    Article  Google Scholar 

  10. Lin FQ, Li C, Zhang LJ, Fu SK, Chen GQ, Yang XH, Zhu CY, Li Q. Effect of rapid plasma volume expansion during anesthesia induction on haemodynamics and oxygen balance in patients undergoing gastrointestinal surgery. Int J Med Sci. 2013;10:355–61.

    Article  CAS  Google Scholar 

  11. Kratz T, Steinfeldt T, Exner M, Dell Orto MC, Timmesfeld N, Kratz C, Skrodzki M, Wulf H, Zoremba M. Impact of focused intraoperative transthoracic echocardiography by anesthesiologists on management in hemodynamically unstable high-risk noncardiac surgery patients. J Cardiothorac Vasc Anesth. 2017;31:602–9.

    Article  Google Scholar 

  12. Adler AC, Greeley WJ, Conlin F, Feldman JM. Perioperative anesthesiology ultrasonographic evaluation (PAUSE): a guided approach to perioperative bedside ultrasound. J Cardiothorac Vasc Anesth. 2016;30:521–9.

    Article  Google Scholar 

  13. Rana S, Verma V, Bhandari S, Sharma S, Koundal V, Chaudhary SK. Point-of-care ultrasound in the airway assessment: a correlation of ultrasonography-guided parameters to the Cormack–Lehane Classification. Saudi J Anaesth. 2018;12:292–6.

    Article  Google Scholar 

  14. Unluer EE, Kara PH. Ultrasonography of jugular vein as marker of hypovolemia in healthy volunteers. Am J Emerg Med. 2013;31:173–7.

    Article  Google Scholar 

  15. Au AK, Steinberg D, Thom C, Shirazi M, Papanagnou D, Ku BS, Fields JM. Ultrasound measurement of inferior vena cava collapse predicts propofol-induced hypotension. Am J Emerg Med. 2016;34:1125–8.

    Article  Google Scholar 

  16. Avcil M, Kapci M, Dagli B, Omurlu IK, Ozluer E, Karaman K, Yilmaz A, Zencir C. Comparision of ultrasound-based methods of jugular vein and inferior vena cava for estimating central venous pressure. Int J Clin Exp Med. 2015;8:10586–94.

    PubMed  PubMed Central  Google Scholar 

  17. Prekker ME, Scott NL, Hart D, Sprenkle MD, Leatherman JW. Point-of-care ultrasound to estimate central venous pressure: a comparison of three techniques. Crit Care Med. 2013;41:833–41.

    Article  Google Scholar 

  18. Simon MA, Kliner DE, Girod JP, Moguillansky D, Villanueva FS, Pacella JJ. Detection of elevated right atrial pressure using a simple bedside ultrasound measure. Am Heart J. 2010;159:421–7.

    Article  Google Scholar 

  19. Broilo F, Meregalli A, Friedman G. Right internal jugular vein distensibility appears to be a surrogate marker for inferior vena cava vein distensibility for evaluating fluid responsiveness. Rev Bras Ter Intensiva. 2015;27:205–11.

    Article  Google Scholar 

  20. Cherpanath TG, Hirsch A, Geerts BF, Lagrand WK, Leeflang MM, Schultz MJ, Groeneveld AB. Predicting fluid responsiveness by passive leg raising: a systematic review and meta-analysis of 23 clinical trials. Crit Care Med. 2016;44:981–91.

    Article  Google Scholar 

  21. Gok F, Sarkilar G, Kilicaslan A, Yosunkaya A, Uzun ST. Comparison of the effect of the Trendelenburg and passive leg raising positions on internal jugular vein size in critically ill patients. Int J Clin Exp Med. 2015;8:19037–43.

    PubMed  PubMed Central  Google Scholar 

  22. Sear JW, Jewkes C, Tellez JC, Foëx P. Does the choice of antihypertensive therapy influence haemodynamic responses to induction, laryngoscopy and intubation? Br J Anaesth. 1994;73:303–8.

    Article  CAS  Google Scholar 

  23. Mets B. Management of hypotension associated with angiotensin–axis blockade and general anesthesia administration. J Cardiothorac Vasc Anesth. 2013;27:156–67.

    Article  Google Scholar 

  24. Vaquero Roncero LM, Sánchez Poveda D, Valdunciel García JJ, Sánchez Barrado ME, Calvo Vecino JM. Perioperative use of angiotensin-converting-enzyme inhibitors and angiotensin receptor antagonists. J Clin Anesth. 2017;40:91–8.

    Article  CAS  Google Scholar 

  25. Kanda Y. Investigation of the freely-available easy-to-use software “EZR” (Easy R) for medical statistics. Bone Marrow Transplant. 2013;48:452–8.

    Article  CAS  Google Scholar 

  26. Reich DL, Hossain S, Krol M, Baez B, Patel P, Bernstein A, Bodian CA. Predictors of hypotension after induction of general anesthesia. Anesth Analg. 2005;101:622–8.

    Article  Google Scholar 

  27. Coste J, Pouchot J. A grey zone for quantitative diagnostic and screening tests. Int J Epidemiol. 2003;32:304–13.

    Article  Google Scholar 

  28. Monnet X, Jabot J, Maizel J, Richard C, Teboul JL. Norepinephrine increases cardiac preload and reduces preload dependency assessed by passive leg raising in septic shock patients. Crit Care Med. 2011;39:689–94.

    Article  CAS  Google Scholar 

  29. Kalmar AF, Allaert S, Pletinckx P, Maes JW, Heerman J, Vos JJ, Struys MMRF, Scheeren TWL. Phenylephrine increases cardiac output by raising cardiac preload in patients with anesthesia induced hypotension. J Clin Monit Comput. 2018;32:969–76.

    Article  CAS  Google Scholar 

  30. Nassar B, Deol GRS, Ashby A, Collett N, Schmidt GA. Trendelenburg position does not increase cross-sectional area of the internal jugular vein predictably. Chest. 2013;144:177–82.

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Anesthesiology, Yokohama City University Hospital, 3-9 Fukuura Kanazawaku, Yokohama, Kanagawa, 236-0027, Japan

    Kenta Okamura

  2. Department of Anesthesiology, School of Medicine, Yokohama City University, Yokohama, Japan

    Takeshi Nomura, Yusuke Mizuno, Tetsuya Miyashita & Takahisa Goto

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  1. Kenta Okamura
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  2. Takeshi Nomura
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  3. Yusuke Mizuno
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  4. Tetsuya Miyashita
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  5. Takahisa Goto
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Correspondence to Kenta Okamura.

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Okamura, K., Nomura, T., Mizuno, Y. et al. Pre-anesthetic ultrasonographic assessment of the internal jugular vein for prediction of hypotension during the induction of general anesthesia. J Anesth 33, 612–619 (2019). https://doi.org/10.1007/s00540-019-02675-9

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  • DOI: https://doi.org/10.1007/s00540-019-02675-9

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