Carotid artery velocity-time integral variation combined with passive leg raising test predicted hypotension after anesthesia induction with an AUC of 0.84, sensitivity of 72.4%, specificity of 97.8%, and cutoff of 13.6% in elderly patients.
Prospective Observational (n=75)
No
Does carotid velocity time integral variation combined with a passive leg raising test predict post-induction hypotension in older patients undergoing general anesthesia?
Carotid velocity-time integral variation combined with a passive leg raising test is a reliable, non-invasive predictor of post-induction hypotension in older patients undergoing general anesthesia.
Estimación del efecto: AUC 0.84 (95% CI 0.74-0.94)
Tasa de eventos absoluta: 39% vs 61%
valor p: p=<0.001
Older patients are at an increased risk of developing hypotension following the induction of general anesthesia, which is linked to a higher incidence of postoperative complications, mortality, and morbidity. This study aimed to investigate the effectiveness of carotid velocity time integral variation (ΔcVTI) combined with the passive leg raising test (PLR) in predicting hypotension after anesthesia induction in elderly patients. This prospective observational study enrolled 75 older patients (65–75 years, ASA II–III) undergoing elective surgery under general anesthesia. Carotid blood flow was continuously monitored using a wearable Doppler ultrasound patch, and ΔcVTI (%) was calculated during passive leg raising. Anesthesia was induced with etomidate, alfentanil, and rocuronium following a standardized protocol. Post-induction hypotension was defined as mean arterial pressure 20% reduction from baseline, or systolic pressure < 90 mmHg within 3 min after induction. The incidence of hypotension observed in the study was 29 cases (39%). The area under the ROC curve for ΔcVTI in predicting hypotension after anesthesia induction was 0.84 (95% CI, 0.74 to 0.94; P < 0.001), with an optimal cutoff value of 13.6%, a sensitivity of 72.4% (95% CI, 54.3–85.3%), and a specificity of 97.8% (95% CI, 88.7–99.6%). Logistic regression analysis identified ΔcVTI as the sole independent risk factor for hypotension following anesthesia induction. ΔcVTI combined with the preoperative passive leg raising test may serve as a simple, non-invasive, and reliable method for predicting anesthetic hypotension in older patients. Clinical Trial Registry on January 8, 2025. (www.chictr.org.cn; ChiCTR2500095534).
Ge et al. (Fri,) conducted a prospective observational in Elderly patients (65-75 years) with ASA physical status II-III undergoing elective surgery under general anesthesia (n=75). Carotid artery velocity-time integral variation (ΔcVTI) combined with passive leg raising test (PLR) vs. No predictive test or standard assessment was evaluated on Prediction of hypotension after anesthesia induction defined as mean arterial pressure <65 mmHg, >20% reduction from baseline, or systolic pressure <90 mmHg within 3 minutes (AUC 0.84, 95% CI 0.74-0.94, p=<0.001). Carotid artery velocity-time integral variation combined with passive leg raising test predicted hypotension after anesthesia induction with an AUC of 0.84, sensitivity of 72.4%, specificity of 97.8%, and cutoff of 13.6% in elderly patients.