From the Department of Anesthesiology and Pain Medicine, Ewha Womans University Mokdong Hospital, Anyangcheon-ro, Yangcheon-gu, Seoul, Korea (MHC), Department of Anesthesiology and Pain Medicine, Ewha Womans University Seoul Hospital, Gonghang-daero, Gangseo-gu (JSC) and Department of Anesthesiology and Pain Medicine, College of Medicine, Ewha Womans University, Gonghang-daero, Gangseo-gu, Seoul, Republic of Korea (HJL, JHW).
Eur J Anaesthesiol. 2020 Jun;37(6):474-481. doi: 10.1097/EJA.0000000000001192.
Bedside sonography of the inferior vena cava has been demonstrated to be a reliable tool for assessing intravascular volume status. Subclavian vein (SCV) assessment was proposed as a reasonable adjunct for measuring the inferior vena cava.
We examined whether the preoperative diameter and collapsibility index of the SCV or the infraclavicular axillary vein could predict the incidence of hypotension after induction of general anaesthesia in patients undergoing laparoscopic cholecystectomy.
Prospective, observational study.
Tertiary university hospital.
Adults scheduled for laparoscopic cholecystectomy.
Sonographic evaluation of the SCV or the axillary vein (SCV-AV) before induction of anaesthesia.
The main outcome was the association between the SCV-AV measurements (diameter an collapsibility index) and intra-operative hypotension (IOH) after induction of anaesthesia.
Patients who developed IOH had a higher collapsibility index of the SCV-AV during spontaneous breathing (P = 0.009) and deep inspiration (P = 0.002). After adjusting for confounding variables, the collapsibility index of the SCV-AV during spontaneous breathing was not a significant predictor of a decrease in mean arterial blood pressure (MAP) after inducing anaesthesia (P = 0.127), whereas the collapsibility index of the SCV-AV during deep inspiration was a significant predictor (P < 0.001).
The collapsibility index of the SCV-AV during deep inspiration was a significant predictor of IOH occurrence and the percentage decrease in MAP after inducing anaesthesia. Further studies in patients with higher collapsibility index are needed to confirm our findings, before the collapsibility index of the SCV-AV can be recommended unequivocally for clinical use.
This trial was registered on 8 September 2017 at the Clinical Trial Registry of Korea (https://cris.nih.go.kr/cris/index.jsp; Identifier: KCT0001078KCT0002457), and the first patient was enrolled on 14 October 2017.
下腔静脉床旁超声已被证明是评估血管内容量状态的可靠工具。锁骨下静脉（SCV）评估被提出作为测量下腔静脉的合理辅助手段。
我们研究了在接受腹腔镜胆囊切除术的患者中，全身麻醉诱导后发生低血压的情况下，SCV 的术前直径和塌陷指数或锁骨下腋静脉是否可以预测其发生率。
前瞻性观察性研究。
三级大学医院。
计划行腹腔镜胆囊切除术的成年人。
全身麻醉诱导前对 SCV 或腋静脉（SCV-AV）进行超声评估。
主要结果是 SCV-AV 测量（直径和塌陷指数）与全身麻醉诱导后术中低血压（IOH）之间的关联。
发生 IOH 的患者在自主呼吸（P=0.009）和深吸气（P=0.002）期间 SCV-AV 的塌陷指数更高。在调整混杂变量后，全身麻醉诱导后 SCV-AV 的自主呼吸期间的塌陷指数不是平均动脉血压（MAP）下降的显著预测因子（P=0.127），而深吸气时 SCV-AV 的塌陷指数是显著的预测因子（P<0.001）。
深吸气时 SCV-AV 的塌陷指数是 IOH 发生和全身麻醉诱导后 MAP 下降百分比的显著预测因子。需要进一步研究具有更高塌陷指数的患者，以确认我们的发现，然后才能明确推荐 SCV-AV 的塌陷指数用于临床应用。
这项试验于 2017 年 9 月 8 日在韩国临床试验注册中心（https://cris.nih.go.kr/cris/index.jsp；标识符：KCT0001078KCT0002457）注册，第一例患者于 2017 年 10 月 14 日入组。
