The Predictive Value Of Inferior Vena Cava Ultrasonography For Postinduction Hypotension In Patients With Esophageal Cancer Undergoing Esophagectomy

Objective:Inferior vena cava ultrasonography is a reliable approach to evaluate volume status.Hypotension was common after induction of general anesthesia and associated with adverse postoperative complications such as myocardial injury,cerebral injury and renal injury.The purpose of this study is to explore whether inferior vena cava diameter and inferior vena cava collapsibility index before general anesthesia can predict hypotension after induction in patient with esophageal cancer undergoing esophagectomy,so as to provide guidance for circulation management during induction.Methods:78 patients scheduled for esophagectomy or gastric-esophageal cancer surgery were recruited.Maximum inferior vena cava diameter(dIVC_max)and minimum inferior vena cava diameter(dIVC_min)were measured,then the inferior vena cava collapsibility?IVC-CI?was calculated.The mean arterial pressure per minute before induction and postintubation was recorded for 10 minutes.Hypotension is defined as a decrease in MAP more than or equal to 30%from baseline or MAP less than or equal to 60mmHg.Receiver operating characteristic curve of dIVC_max,dIVC_min and IVC-CI were drawn to analyze the predictive value of dIVC_max,dIVC_min and IVC-CI for hypotension after induction.Results:Data from 70 patients were finally analyzed,35 patients of them developed hypotension.The 70 patients were divided into Y group?Yes?and N group?No?according to whether there was hypotension after induction,no significant differences were found in dIVC_maxax and IVC-CI between group Y and N?P>0.05?;Areas?95%confidence interval?under the ROC curves of dIVC_max,dIVC_minin and IVC-CI were 0.597?0.460-0.727?,0.616?0.484-0.747?and 0.593?0.462-0.732?respectively;The optimal cutoff values were 1.59cm for dIVC_max,1.07cm for dIVC_min and 44%for IVC-CI.Among the 70 patients,45 patients were normotensive patients,of all the 45 normotensive patients,20 developed hypotension after induction of general anesthesia,The 45 normotensive patients were divided into Y₀ group?Yes₀?and N₀ group?No₀?according to whether there was hypotension after induction,no significant differences were found in dIVC_max and dIVC_minin between group Y₀ and N₀?P>0.05?,IVC-CI was significant higher in Y₀group compared with N₀ group?P<0.01?;Areas?95%confidence interval?under the ROC curves in normotensive patients were 0.545?0.374-0.716?for dIVC_max,0.618?0.453-0.783?for dIVC_min,and 0.761?0.611-0.911?for IVC-CI.The optimal cutoff values were 1.65cm for dIVC_max,1.06cm for dIVC_min and 44%for IVC-CI.Among the 70 patients,25 patients had a history of hypertension,among the 25 hypertensive patients,15 developed hypotension after induction of general anesthesia.The 25 hypertensive patients were divided into Y₁ group?Yes₁?and N₁ group?No₁?according to whether there was hypotension after induction,no significant differences were found in dIVC_max and IVC-CI between group Y₁ and N₁?P>0.05?;Areas?95%confidence interval?under the ROC curves of dIVC_max,dIVC_minin and IVC-CI in hypertensive patients were 0.670?0.454-0.886?,0.633?0.409-0.858?and 0.527?0.287-0.766?respectively;The optimal cutoff values were 1.46cm for dIVC_max,1.15cm for dIVC_min and 34.5%for IVC-CI.Conclusions:IVC-CI had a high predictive value for postinduction hypotension in normotensive patients with esophageal cancer undergoing esophagectomy,when IVC-CI was greater than 44%,the patients were likely to develop hypotension after induction.