What does this research mean for the field?

Carotid velocity time integral variation combined with the passive leg raising test predicts hypotension after anesthesia induction in older patients with a sensitivity of 72.4% and specificity of 97.8%. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

This study aims to evaluate if carotid velocity-time integral variation can effectively predict hypotension in older patients post-anesthesia induction.

March 8, 2026Open Access

Carotid artery velocity-time integral variation combined with passive leg raising test to predict hypotension after induction in older patients under general anesthesia: a prospective study

Q: What is the clinical evidence from this study?

Study design: Prospective Observational. Population: Elderly patients (65-75 years) with ASA physical status II-III undergoing elective surgery under general anesthesia (n=75). Intervention: Carotid artery velocity-time integral variation (ΔcVTI) combined with passive leg raising test (PLR) vs. No predictive test or standard assessment. Primary outcome: Prediction of hypotension after anesthesia induction defined as mean arterial pressure 20% reduction from baseline, or systolic pressure <90 mmHg within 3 minutes (AUC 0.84, 95% CI 0.74-0.94, p=<0.001).

Key Result

Carotid artery velocity-time integral variation combined with passive leg raising test predicted hypotension after anesthesia induction with an AUC of 0.84, sensitivity of 72.4%, specificity of 97.8%, and cutoff of 13.6% in elderly patients.

Key Points

This study aims to evaluate if carotid velocity-time integral variation can effectively predict hypotension in older patients post-anesthesia induction.
Conducted a prospective observational study with 75 older patients undergoing elective surgery.
Monitored carotid blood flow using a wearable Doppler ultrasound patch.
Combined ΔcVTI with the passive leg raising test to assess risk of hypotension.
Defined hypotension as mean arterial pressure < 65 mmHg or a > 20% decrease from baseline.
Observed hypotension incidence was 39% (29 out of 75 patients).
ΔcVTI showed an area under the ROC curve of 0.84 for predicting hypotension.
Optimal ΔcVTI cutoff value was 13.6%, with sensitivity at 72.4% and specificity at 97.8%.
ΔcVTI identified as the only independent risk factor for hypotension.

Study Design

Type

Prospective Observational (n=75)

Multicenter

Structured PICO

Does carotid velocity time integral variation combined with a passive leg raising test predict post-induction hypotension in older patients undergoing general anesthesia?

Population

75 older patients (aged 65-75 years, ASA II-III) scheduled for elective surgery under general anesthesia. Exclusions: BMI <18 or >30 kg/m2, diabetes, coronary artery disease, heart conditions (cardiomyopathy, moderate to severe valvular disorders), pulmonary hypertension, preoperative hypertension, atherosclerosis, cervical vascular ultrasound irregularities, and prior neck surgery or trauma.

Intervention

Carotid velocity time integral variation (ΔcVTI) measured via a wearable Doppler ultrasound patch during a passive leg raising test (PLR) prior to anesthesia induction.

Outcome

Post-induction hypotension (defined as mean arterial pressure < 65 mmHg, a > 20% reduction from baseline, or systolic pressure < 90 mmHg within 3 min after induction)surrogate

Carotid velocity-time integral variation combined with a passive leg raising test is a reliable, non-invasive predictor of post-induction hypotension in older patients undergoing general anesthesia.

Main Result

Effect estimate: AUC 0.84 (95% CI 0.74-0.94)

Absolute Event Rate: 39% vs 61%

p-value: p=<0.001

Limitations

Single-center study
Small sample size (n=75)
Exclusion of patients with significant comorbidities may limit generalizability
Observational design limits causal inference

Abstract

Older patients are at an increased risk of developing hypotension following the induction of general anesthesia, which is linked to a higher incidence of postoperative complications, mortality, and morbidity. This study aimed to investigate the effectiveness of carotid velocity time integral variation (ΔcVTI) combined with the passive leg raising test (PLR) in predicting hypotension after anesthesia induction in elderly patients. This prospective observational study enrolled 75 older patients (65–75 years, ASA II–III) undergoing elective surgery under general anesthesia. Carotid blood flow was continuously monitored using a wearable Doppler ultrasound patch, and ΔcVTI (%) was calculated during passive leg raising. Anesthesia was induced with etomidate, alfentanil, and rocuronium following a standardized protocol. Post-induction hypotension was defined as mean arterial pressure 20% reduction from baseline, or systolic pressure < 90 mmHg within 3 min after induction. The incidence of hypotension observed in the study was 29 cases (39%). The area under the ROC curve for ΔcVTI in predicting hypotension after anesthesia induction was 0.84 (95% CI, 0.74 to 0.94; P < 0.001), with an optimal cutoff value of 13.6%, a sensitivity of 72.4% (95% CI, 54.3–85.3%), and a specificity of 97.8% (95% CI, 88.7–99.6%). Logistic regression analysis identified ΔcVTI as the sole independent risk factor for hypotension following anesthesia induction. ΔcVTI combined with the preoperative passive leg raising test may serve as a simple, non-invasive, and reliable method for predicting anesthetic hypotension in older patients. Clinical Trial Registry on January 8, 2025. (www.chictr.org.cn; ChiCTR2500095534).

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Cite This Study

Ge et al. (Fri,) conducted a prospective observational in Elderly patients (65-75 years) with ASA physical status II-III undergoing elective surgery under general anesthesia (n=75). Carotid artery velocity-time integral variation (ΔcVTI) combined with passive leg raising test (PLR) vs. No predictive test or standard assessment was evaluated on Prediction of hypotension after anesthesia induction defined as mean arterial pressure <65 mmHg, >20% reduction from baseline, or systolic pressure <90 mmHg within 3 minutes (AUC 0.84, 95% CI 0.74-0.94, p=<0.001). Carotid artery velocity-time integral variation combined with passive leg raising test predicted hypotension after anesthesia induction with an AUC of 0.84, sensitivity of 72.4%, specificity of 97.8%, and cutoff of 13.6% in elderly patients.

synapsesocial.com/papers/69ada873bc08abd80d5bb5d4 https://doi.org/https://doi.org/10.1186/s12877-026-07267-3

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