Feasibility of Anesthesiologist-Performed Preoperative Echocardiography for the Prediction of Postinduction Hypotension: A Prospective Observational Study.

Abstract

Purpose: To determine if left ventricular or inferior vena cava (IVC) measurements are easier to obtain on point-of-care ultrasound by anesthesiologists in preoperative patients, and to assess the relationship between preoperative cardiac dimensions and hypotension with the induction of general anesthesia.

Methods: This prospective observational study was conducted at a large academic medical center. Sixty-three patients undergoing noncardiac surgeries under general anesthesia were enrolled. Ultrasound examinations were performed by anesthesiologists in the preoperative area. To ensure that hypotension represented both a relative and absolute decrease in blood pressure, both a mean arterial pressure (MAP) < 65 mmHg and a MAP decrease of >30% from preoperative value defined this outcome.

Results: Left ventricular measurements were more likely to be acquired than IVC measurements (97% vs. 79%). Subjects without adequate images to assess IVC collapsibility tended to have a higher body mass index (33.6 ± 5.5 vs. 28.5 ± 4.5, p=0.001). While high left ventricular end-diastolic diameter values were associated with a decreased odds of MAP < 65 mmHg (OR: 0.24, 95% CI: 0.07-0.83, p=0.023) or a MAP decrease of >30% from baseline alone (OR: 0.25, 95% CI: 0.07-0.83, p=0.023), the primary endpoint of both relative and absolute hypotension was not associated with preoperative left ventricular dimensions.

Conclusions: Preoperative cardiac ultrasound may be a more reliable way for anesthesiologists to assess patients' volume status compared to ultrasound of the IVC, particularly for patients with a higher body mass index.