Transthoracic Echocardiography for Assessing the Preoperative Hypovolemia in Patients with Aneurysmal Subarachnoid Hemorrhage: A Prospective Observational Study.
Guru C Desari, Kiran Jangra, Virendra K Arya, Sabina Regmi, Ashish Aggarwal, Hemant Bhagat, Nidhi B Panda, Shiv L Soni, Summit D Bloria
{"title":"Transthoracic Echocardiography for Assessing the Preoperative Hypovolemia in Patients with Aneurysmal Subarachnoid Hemorrhage: A Prospective Observational Study.","authors":"Guru C Desari, Kiran Jangra, Virendra K Arya, Sabina Regmi, Ashish Aggarwal, Hemant Bhagat, Nidhi B Panda, Shiv L Soni, Summit D Bloria","doi":"10.4103/neurol-india.Neurol-India-D-23-00265","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Volume disturbances frequently occur after aneurysmal subarachnoid hemorrhage (a-SAH). Both hypovolemia and hypervolemia are associated with poor outcomes. Hence, we planned this study to determine preoperative volume status using echocardiography.</p><p><strong>Objectives: </strong>The primary objective was to determine the incidence of preoperative hypovolemia in a-SAH patients with echocardiography. The secondary objectives include association between hypovolemia and induction hypotension and relative risk, and relative sensitivity and specificity of echocardiographic indices in predicting induction hypotension.</p><p><strong>Methods and material: </strong>Ninety-eight ASA-I or -II patients, aged 18-65 years, undergoing aneurysmal clipping surgery were included. Hypovolemia was assessed by inferior vena cava (IVC) diameter, IVC collapsibility index in subcostal view, left ventricular end-diastolic area and kissing-papillary sign in parasternal short axis view, and variations in left-ventricular outflow tract velocity-time integral (LVOT-VTI) in apical view. Induction-hypotension was defined as mean arterial pressure <70 mm of Hg until 10 min after induction.</p><p><strong>Results: </strong>Out of 98 patients, 69 (70%) were hypovolemic and 59 (60%) developed induction hypotension with a relative risk of 2.26. The IVC-Cx and LVOT-VTI were the most sensitive parameters for determining induction hypotension (76% and 91%, respectively). A combination of IVC-Cx and kissing-papillary signs were most reliable for determining induction hypotension (P = 0.010).</p><p><strong>Conclusions: </strong>We conclude that the incidence of preoperative hypovolemia was 70%, and 60% of patients had induction hypotension. Dynamic parameters including IVC-Cx and VTI-variations are more reliable in predicting induction hypotension. We emphasize that preoperative screening of patients using ultrasound helps identify the hypovolemic patients in the preoperative area.</p>","PeriodicalId":19429,"journal":{"name":"Neurology India","volume":"73 3","pages":"474-479"},"PeriodicalIF":0.9000,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Neurology India","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.4103/neurol-india.Neurol-India-D-23-00265","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/5/23 0:00:00","PubModel":"Epub","JCR":"Q4","JCRName":"NEUROSCIENCES","Score":null,"Total":0}
引用次数: 0
Abstract
Background: Volume disturbances frequently occur after aneurysmal subarachnoid hemorrhage (a-SAH). Both hypovolemia and hypervolemia are associated with poor outcomes. Hence, we planned this study to determine preoperative volume status using echocardiography.
Objectives: The primary objective was to determine the incidence of preoperative hypovolemia in a-SAH patients with echocardiography. The secondary objectives include association between hypovolemia and induction hypotension and relative risk, and relative sensitivity and specificity of echocardiographic indices in predicting induction hypotension.
Methods and material: Ninety-eight ASA-I or -II patients, aged 18-65 years, undergoing aneurysmal clipping surgery were included. Hypovolemia was assessed by inferior vena cava (IVC) diameter, IVC collapsibility index in subcostal view, left ventricular end-diastolic area and kissing-papillary sign in parasternal short axis view, and variations in left-ventricular outflow tract velocity-time integral (LVOT-VTI) in apical view. Induction-hypotension was defined as mean arterial pressure <70 mm of Hg until 10 min after induction.
Results: Out of 98 patients, 69 (70%) were hypovolemic and 59 (60%) developed induction hypotension with a relative risk of 2.26. The IVC-Cx and LVOT-VTI were the most sensitive parameters for determining induction hypotension (76% and 91%, respectively). A combination of IVC-Cx and kissing-papillary signs were most reliable for determining induction hypotension (P = 0.010).
Conclusions: We conclude that the incidence of preoperative hypovolemia was 70%, and 60% of patients had induction hypotension. Dynamic parameters including IVC-Cx and VTI-variations are more reliable in predicting induction hypotension. We emphasize that preoperative screening of patients using ultrasound helps identify the hypovolemic patients in the preoperative area.
期刊介绍：
Neurology India (ISSN 0028-3886) is Bi-monthly publication of Neurological Society of India. Neurology India, the show window of the progress of Neurological Sciences in India, has successfully completed 50 years of publication in the year 2002. ‘Neurology India’, along with the Neurological Society of India, has grown stronger with the passing of every year. The full articles of the journal are now available on internet with more than 20000 visitors in a month and the journal is indexed in MEDLINE and Index Medicus, Current Contents, Neuroscience Citation Index and EMBASE in addition to 10 other indexing avenues.
This specialty journal reaches to about 2000 neurologists, neurosurgeons, neuro-psychiatrists, and others working in the fields of neurology.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
