Assessing the Utility of Ultrasonographic Vein Collapsibility Index in Anticipating Hypotension during Spinal Anesthesia for Cesarean Sections

Abstract

Background and Objectives: Hypotension following spinal anesthesia, termed Post Spinal Anesthesia Hypotension (PSAH), is a common occurrence in anesthetic practice, particularly in the context of cesarean sections. Utilizing ultrasound as a secure and uncomplicated technique for hemodynamic monitoring has gained prominence. This study aimed to evaluate the effectiveness of pre-operative measurements of the Inferior Vena Cava Collapsibility Index (IVCCI) and Internal Jugular Vein Collapsibility Index (IJVCI) in predicting PSAH. Methods: In this cross-sectional blinded study, 76 pregnant females scheduled for elective cesarean section were included. They were categorized into two groups based on the presence of PSAH: (1) 37 cases with PSAH; and (2) 39 cases without PSAH. All participants underwent ultrasound-guided assessments of IVCCI and IJVCI. The predictive potential of these parameters for PSAH was scrutinized.
Results: Both groups exhibited non-significant differences in demographic characteristics. Nevertheless, IVCCI demonstrated mean values of 37.62% and 28.36%, whereas IJVCI showed mean values of 47.82% and 32.79% in cases with and without PSAH, respectively. For IVCCI, employing a threshold of 32.5% yielded a sensitivity and specificity of 85.2% and 92.7%, respectively, for predicting PSAH, with an overall diagnostic accuracy of 88.6%. IJVCI, with a cut-off value of 39%, exhibited a sensitivity and specificity of 84.2% and 83.4%,
respectively, in predicting the same complication.
Conclusion: IVCCI and IJVCI emerged as effective and dependable tools for predicting PSAH in pregnant women undergoing cesarean section, with a slight advantage for IVCCI in terms of specificity and overall accuracy