Wei Xue-Lian, Xi Ya-Zhi, Xie Lei, Li Zhen-Ping, Tang Huan-Liang, Zhou Qing-He
Department of Anesthesiology and Pain Medicine, the Affiliated Hospital of Jiaxing University, No.1882, Ring 2nd South Road, Jiaxing City, 314000, Zhejiang Province, China.
BMC Anesthesiol. 2025 Jul 17;25(1):350. doi: 10.1186/s12871-025-03227-3.
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.
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.
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).
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.
Successfully registered on Clinicaltrials.gov on November 1, 2023 (NCT06112769) and on August 1, 2024 (NCT06641505).
目前缺乏可靠预测全身麻醉诱导期间患者低血压的方法。深度吸气已被证明可增强颈内静脉（IJV）的变异性。在本研究中，我们旨在探讨深度吸气期间颈内静脉变异性（IJVV）与丙泊酚诱导期间血压下降程度之间的关系，以及利用IJVV作为麻醉前液体复苏指导的潜力。
在全身麻醉诱导前，进行床旁超声测量以评估颈内静脉的最大直径（IJVmax-D）和最小直径（IJVmin-D）以及最大横截面积（IJVmax-A）和最小横截面积（IJVmin-A），然后计算颈内静脉直径变异性（IJVV-D）和颈内静脉面积变异性（IJVV-A）。采用受试者工作特征（ROC）曲线确定IJVV-D和IJVV-A对预测丙泊酚诱导性低血压（血压下降≥20%）的诊断价值并计算临界值。以下前瞻性随机对照试验旨在比较变异性值>最佳临界值的患者中，IJVV-D或IJVV-A指导补液组（A组）和标准补液组（B组）之间麻醉诱导性低血压的发生率。观察并比较两组在丙泊酚诱导期低血压的发生率。
最终分析共纳入60例患者。IJVV-A与深度吸气期间血压下降程度之间存在显著的强相关性（r = 0.858，p < 0.001）。IJVV-A的AUC为0.900（95%CI 0.821 - 0.979，p < 0.001），临界值为23.42%（敏感性：81.5%，特异性：84.8%）。同时，共有87例深度吸气期间IJVV-A>23.42%的患者纳入数据分析。A组低血压发生率为26.8%，B组为63.0%，差异有统计学意义（P < 0.001）。
观察到深度吸气期间IJVV水平与丙泊酚诱导后血压下降之间存在显著关系。通过在深吸气期间使IJVV-A保持低于23.42%，给予IJVV-A指导的液体输注可显著降低丙泊酚诱导的低血压。
于2023年11月1日在Clinicaltrials.gov成功注册（NCT06112769），并于2024年8月1日（NCT0664150）成功注册。
