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Observational Study
. 2024 Nov;34(11):363-368.
doi: 10.1177/17504589231215932. Epub 2023 Dec 27.

Comparing preoperative fasting and ultrasound-measured intravascular volume status in elective surgery, enhanced recovery patients versus inpatient, urgent surgery patients and the ability of IVC collapsibility to predict post-induction hypotension

Jacob R Wrobel  1 , Justin C Magin  1 , David Williams  2 , Xinming An  1 , Jacob D Acton  1 , Alexander S Doyal  1 , Shawn Jia  1 , James C Krakowski  1 , Ricardo Serrano  1 , Stuart A Grant  1 , David N Flynn  1 , Duncan J McLean  1
Affiliations
Observational Study

Comparing preoperative fasting and ultrasound-measured intravascular volume status in elective surgery, enhanced recovery patients versus inpatient, urgent surgery patients and the ability of IVC collapsibility to predict post-induction hypotension

Jacob R Wrobel et al. J Perioper Pract. 2024 Nov.

Abstract

Hypotension following induction of general anaesthesia has been shown to result in increased complications and mortality postoperatively. Patients admitted to the hospital undergoing urgent surgery are often fasted from fluids for significant periods compared to elective patients subject to Enhanced Recovery After Surgery protocols despite guidelines stating that a two-hour fast is sufficient. The aim of this prospective, observational study was to compare fasting times and intravascular volume status between elective surgery patients subject to enhanced recovery protocols and inpatient, urgent surgery patients and to assess differences in the incidence of post-induction hypotension. Fasting data was obtained by questionnaire in the preoperative area in addition to inferior vena cava collapsibility index, a non-invasive measure of intravascular volume. Blood pressure readings and drug administration for the ten minutes following induction were obtained from patients' charts. Inpatients undergoing urgent surgery were fasted significantly longer than enhanced recovery patients and had lower intravascular volume. However, no difference was found in the incidence of post-induction hypotension.

Keywords: Enhanced recovery; IVC collapsibility; POCUS; Perioperative medicine.

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Conflict of interest statement

The author(s) declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.

Figures

Figure 1
Figure 1
This image shows the M-mode measurement of a highly collapsible IVC. The minimum diameter coincides with the decrease in vessel calibre associated with the patient sniffing in through their nose.
Figure 2
Figure 2
This flowchart illustrates the total recruitment for the study and the reasons for exclusion from certain aspects of data collection.
Figure 3
Figure 3
This receiver-operating characteristic curve shows the change in sensitivity of IVC collapsibility for predicting hypotension as a function of 1 − specificity, or false-positive rate. Three IVC collapsibility values are provided for reference on the curve and the area under the curve (AUC) is provided.
See this image and copyright information in PMC

References

    1. American Society of Anesthesiologists 2017. Practice guidelines for preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration: Application to healthy patients undergoing elective procedures: An updated report by the American Society of Anesthesiologists Task Force on preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration Anesthesiology 126 (3) 376–393 - PubMed
    1. Bijker JB, van Klei WA, Kappen TH, van Wolfswinkel L, Moons KGM, Kalkman CJ. 2007. Incidence of intraoperative hypotension as a function of the chosen definition Anesthesiology 107 (2) 213–220 - PubMed
    1. Ciozda W, Kedan I, Kehl DW, Zimmer R, Khandwalla R, Kimchi A. 2015. The efficacy of sonographic measurement of inferior vena cava diameter as an estimate of central venous pressure Cardiovascular Ultrasound 14(1) 13 - PMC - PubMed
    1. El-Sharkawy AM, Daliya P, Lewis-Lloyd C, et al. 2020. Fasting and surgery timing (FaST) audit Clinical Nutrition 40(3) 1405–1412 - PMC - PubMed
    1. Fawcett WJ, Thomas M. 2018. Pre-operative fasting in adults and children: Clinical practice and guidelines Anaesthesia 74 (1) 83–88 - PubMed

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