Effects of liquid resuscitation guided by internal jugular vein variability during deep inhalation on preventing propofol-induced hypotension in elderly patients.

Background: Methods for reliably predicting hypotension in patients during general anesthesia induction are currently lacking. Deep inhalation has been shown to enhance the variability of the internal jugular vein (IJV). In this study, we aim to investigate the relationship between internal jugular vein variability (IJVV) during deep inhalation and the extent of blood pressure decrease during propofol induction, as well as the potential of utilizing IJVV as a guide for pre-anesthesia fluid resuscitation.

Methods: Before general anesthesia induction, bedside ultrasonic measurement was performed to evaluate the maximum diameter (IJVmax-D) and minimum diameter (IJVmin-D) of the IJV and the maximum cross-sectional area (IJVmax-A) and minimum cross-sectional area (IJVmin-A), and then calculated the IJV diameter variability (IJVV-D) and IJV area variability (IJVV-A). A receiver operating characteristic (ROC) curve was used to determine the diagnostic value of IJVV-D and IJVV-A for predicting propofol induced hypotension (blood pressure decreased ≥ 20%) and calculate the cut-off value. The following prospective randomized controlled trial aimed to compare the incidence of anesthesia-induced hypotension between the IJVV-D or IJVV-A guided fluid administration (Group A) and the standard fluid administration group (Group B) in patients with the variability value > optimal cut-off value. The occurrence rate of hypotension during the propofol induction period was observed and compared between the two groups.

Results: A total of 60 patients were included in the final analysis. A significant strong correlation exists between IJVV-A and the degree of blood pressure decrease during deep inhalation (r = 0.858, p < 0.001). The AUC of IJVV-A was 0.900 (95% CI 0.821-0.979, p < 0.001) with a cut-off value of 23.42% (sensitivity: 81.5%, specificity: 84.8%). At the same time, a total of 87 patients with IJVV-A > 23.42% during deep inhalation were included in the data analysis. The incidence of hypotension in Group A was 26.8%, compared to 63.0% in Group B, revealing a statistically significant difference (P < 0.001).

Conclusions: A significant relationship was observed between IJVV levels during deep inhalation and the blood pressure decline following propofol induction. Administering IJVV-A guided fluid infusion can significantly reduce propofol-induced hypotension by keeping the IJVV-A less than 23.42% during deep inspiration.

Trial registration: Successfully registered on Clinicaltrials.gov on November 1, 2023 (NCT06112769) and on August 1, 2024 (NCT06641505).