The Use of the Internal Jugular Vein Collapsibility Index (IJVCI) for the Prediction of Postspinal Hypotension in Geriatric Patients Posted for Lower Limb Surgeries

Background and aims Hypotension is a recognized consequence of subarachnoid block (SAB). Sonographic measurements of inferior vena cava (IVC) index have been explored to assess intravascular volume. Internal jugular vein (IJV) assessment as a surrogate has been used in pregnant patients, but data is lacking in geriatric patients. Hence, we performed this study to find the ability of the IJV collapsibility index (IJVCI) to predict postspinal hypotension (PSH). Materials and methods This prospective observational study was conducted in 60 years above American Society of Anaesthesiologists (ASA) I-III patients undergoing surgeries under SAB. Ultrasonography of the IJV was done in a supine position, and IJVCI% was calculated. The baseline hemodynamic parameters were noted, followed by every one minute for three minutes and every five minutes till 20 minutes after spinal anesthesia. Decrease in systolic blood pressure (SBP) of more than 20% from baseline or mean arterial pressure (MAP) of less than 65 mm Hg was considered as PSH. Quantitative variables and categorical data were compared using the Mann-Whitney U test and chi-square test, respectively. A p-value < 0.05 was considered statistically significant. Results Out of 52 patients, 29 (55.76%) developed PSH, seen commonly among ASA III patients and patients with higher baseline SBP. IJVCI was significantly higher in the hypotensive group with mean values of 53.11±11.52 versus 40.96±12.20 in the non-hypotensive group. The receiver operator characteristics curve (ROC) was drawn with an area under the curve (AUC) value of 0.769 with a sensitivity of 89.7% and specificity of 69.6%. Conclusion The simplicity and noninvasiveness of IJV sonography make IJVCI useful for predicting PSH in elderly patients.