Preoperative Ultrasonographic Assessment of Caval-Aortic Index and Inferior Vena Cava Collapsibility Index for Predicting Postinduction Hypotension During General Anesthesia: A Prospective Observational Study
Journal of Cardiothoracic and Vascular Anesthesia, cilt.40, sa.10, ss.3183-3192, 2026 (SCI-Expanded, Scopus)
- Yayın Türü: Makale / Tam Makale
- Cilt numarası: 40 Sayı: 10
- Basım Tarihi: 2026
- Doi Numarası: 10.1053/j.jvca.2026.06.028
- Dergi Adı: Journal of Cardiothoracic and Vascular Anesthesia
- Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus, EMBASE, MEDLINE
- Sayfa Sayıları: ss.3183-3192
- Anahtar Kelimeler: caval-aortic index, general anesthesia, inferior vena cava collapsibility index, postinduction hypotension, ultrasonography
- Sağlık Bilimleri Üniversitesi Adresli: Evet
Özet
Objectives: This study aimed to compare the predictive performance of the inferior vena cava collapsibility index (IVC-CI) and the caval-aortic (IVC:Ao) index for postinduction hypotension. Design: Prospective observational study. Setting: Tertiary care university hospital. Participants: One hundred adult patients scheduled for elective surgery under general anesthesia. Interventions: Before anesthetic induction, ultrasonographic measurements of the inferior vena cava and abdominal aorta were obtained in the supine position. The IVC-CI and IVC:Ao index were calculated using standard definitions. Mean arterial pressures were recorded every 2 minutes for 10 minutes following induction of anesthesia. Measurements and Main Results: Postinduction hypotension occurred in 68 patients (68%). The IVC:Ao index demonstrated excellent discriminative performance (area under the curve [AUC], 0.971; 95% confidence interval [CI], 0.916-0.994) and significantly outperformed the IVC-CI (AUC, 0.846; 95% CI, 0.760-0.910; p = 0.025). An IVC:Ao index cutoff value ≤1.1 yielded a sensitivity of 94.1% and a specificity of 93.8%, with a narrow gray zone (values yielding both sensitivity and specificity <90%) including 10% of patients, compared with 53% for the IVC-CI. In multivariable analyses, each 0.1-unit decrease in the IVC:Ao index was associated with increased odds of hypotension (odds ratio, 4.95; 95% CI, 2.43-10.09; p < 0.001). Similarly, each 10-point increase in the IVC-CI was independently associated with hypotension (odds ratio, 6.17; 95% CI, 2.66-14.31; p < 0.001). Conclusions: Preoperative ultrasonographic assessment of the IVC:Ao index provides superior predictive performance and a substantially narrower gray zone compared with the IVC-CI for identifying patients at risk of postinduction hypotension.