The relationship between the collapsibility index of the internal jugular vein and spinal anesthesia-induced hypotension in Cesarean section

Abstract

Objective: We aimed to investigate the sonographic assessments of internal jugular vein (IJV) to predict spinal anesthesia induced-hypotension in pregnant patients undergoing a cesarean section.Design: A prospective, observational studySetting: Bursa Yuksek Ihtisas Training and Research HospitalSubjects: Seventy-nine American Society of Anesthesiologists physical status II, healthy pregnant women at term aged over 18 years who were scheduled for an elective cesarean section with spinal anesthesia were included in the study.Intervention: Sonographic assessment of the IJV was made in the supine position with an estimated 15 degrees left lateral table tilt before spinal anesthesia. Spinal anesthesia was performed for all patients. We administered 20 mL/kg crystalloid to patients as co-loading. Collapsibility index (CI) [(dIIJVmax-dIJVmin)/dIJVmax x 100%], aspect ratio (height/width), and the maximum diameter of the IJV (dIJVmax) were measured preoperatively. The upper sensory level was assessed. Hypotension was defined as a more than 20% decrease in systolic blood pressure from the baseline level.Main outcome measure: The relationship between spinal anesthesia-induced hypotension and dIJVmax, IJV-CI and IJV aspect ratio.Results: Seventy-three patients were analyzed. The incidence of hypotension was 60.3% (n=44). There were no significant differences in IJV-CI (50 +/- 1.6, 51 +/- 2), IJV aspect ratio (1.02 +/- 0.30, 1.11 +/- 0.50) and dIJVmax (1.00 +/- 0.36, 1.03 +/- 0.26) between developed hypotension group and undeveloped hypotension group. The upper sensory level was also not significantly different between the groups.Conclusion: We found that dIJVmax, IJV aspect ratio and IJV-CI were not predictive of spinal anesthesia-induced hypotension for cesarean section.