Şevki SARI, Şule ARICAN, Ahmet TOPAL, Gülçin HACIBEYOĞLU, Sema TUNCER UZUN

Preoperatif vena cava inferior ultrasonografisi gastrointestinal cerrahi altindaki hastalarda indüksiyon sonrası hipotansiyonu tahmin edebilir

Amaç: Bu çalışmada, preoperatif inferior vena kava ultrasonografisinin anestezi indüksiyonu sonrası gelişen hipotansiyonu öngörmede etkinliğini ve ikincil olarak bağırsak hazırlığı yapılan hastalarda oluşan hipovolemiyi tesbitini değerlendirmeyi amaçladık.Gereç ve Yöntem: Genel anestezi altında gastrointestinal cerrahi operasyon geçirecek 18-65 yaş arası American Society of Anaesthesiologists physical status classification (ASA) I-II hastalar dahil edildi. Çalışmaya dahil edilen 84 olgunun 42’sine barsak hazırlığı yapılmıştı. Hastaların inferior vena kava maksimun çapı (dİVK maks) ve inferior vena kava minimum çapı (dİVK min), inferior vena kava kollabsibilite indeksi (İVK-Kİ, indüksiyon öncesi bazal ortalama arter basıncı (OAB) ve İndüksiyon sonrası cerrahi insizyona kadar hastaların kan basıncı ölçümleri ölçüldü. Bulgular: Çalışmaya dahil edilen 84 hastanın 39’unda (% 46.4) genel anestezi indüksiyonundan sonra hipotansiyon gelişti. ROC eğrisi analizi ile dİVK maks için cut-off değeri 15.750 mm olarak bulundu. 15.750 mm cut-off değeri için spesifite ve sensitivite sırasıyla %55.6-%71.8 olarak bulundu. ROC eğrisi analizi ile İVK-Kİ için cut-off değeri 32.7460 olarak bulundu. 32.7460 cut-off değeri için spesifite ve sensitivite sırasıyla %83.3-%74.4 olarak bulundu. Sonuç: İnferior vena kava ultrasonografisi hastalarda preoperatif hipovolemiyi öngörmede faydalı olabilir. Verilerimize göre barsak hazırlığı yapılmayan hastalarla karşılaştırıldığında barsak hazırlığı yapılan hastalarda yüksek İVK-Kİ ve düşük dİVK maks değerleri ve yüksek hipotansiyon insidansı görülmüştür.

Anahtar Kelimeler:

anesthesia, colorectal surgery, propofol

Preoperative inferior vena cava ultrasonography can predict post-induction hypotension in patients undergoing gastrointestinal surgery

Purpose: In this study we aimed to evaluate effectiveness of preoperative IVC ultrasonography in predicting hypotension which develops following anesthesia induction, and in determining hypovolemia occurring in patients undergoing bowel preparation as secondary outcomes. Materials and Methods: The study included patients with American Society of Anesthesiologists physical status classification (ASA) I-II, aged between 18 and 65 years who were scheduled for gastrointestinal operation under general anesthesia. Fourty-two of the 84 patients included underwent bowel preparation. Patients’ maximum diameter of inferior vena cava (dIVCmax) and minimum diameter of inferior vena cava (dIVCmin), inferior vena cava collapsibility index (IVC-CI) and preinduction basal mean arterial pressure (MAP) was measured. Results: Thirty-nine (46.4%) of the 84 patients developed hypotension after general anesthesia induction. Cut-off for dIVCmax was found as 15.750 mm with ROC analysis. Specificity and sensitivity for the cut-off value of 15.750 mm were calculated as 55.6% and 71.8%, respectively. Cut-off for IVC-CI was found as 32.746 % with ROC analysis. Specificity and sensitivity for the cut-off value of 32.746 % mm were calculated as 83.3% and 74.4%, respectively. Conclusion: According to our data, IVC ultrasonography may be helpful in prediction of preoperative hypovolemia in patients. IVC-CI was higher and dIVCmax was lower and the incidence of hypotension was higher in patients who underwent bowel preparation compared to the patient who did not undergo.

Keywords:

hypotension hypovolemia, ultrasonography, vena cava inferior,

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