Skip to main content
Download PDF

Role of the inferior vena cava collapsibility index in predicting propofol-induced hypotension in patients undergoing colonoscopy

BMC Anesthesiology volume 25, Article number: 73 (2025) Cite this article

Abstract

Background

Hypotension is a common side effect of propofol induction, and when severe, it is associated with adverse outcomes. Ultrasonography of the inferior vena cava (IVC) is a reliable indicator of the intravascular volume. This study investigated whether preoperative IVC ultrasound measurements could predict hypotension after propofol induction in patients undergoing colonoscopies.

Methods

Sixty-two adult patients with American Society of Anesthesiologists physical status (ASA) I-II scheduled for colonoscopy after propofol induction were recruited. The Ultrasound Maximum IVC diameter (dIVCmax), minimum IVC diameter (dIVCmin), and collapsibility index (IVC-CI) were assessed in all patients before propofol induction. Mean blood pressure (MBP) was recorded before induction. Propofol was injected intravenously after ultrasound measurements. MBP was recorded 1, 3, 5, and 10 min after propofol induction. The receiver operating characteristic (ROC) curve of IVC-CI was compared with that of patients who developed hypotension after propofol induction.

Results

Sixty-two patients completed the study, and their data were considered for statistical analysis. After induction,30 patients developed hypotension. The area under the curve (95% confidence interval) was 0.72 (0.595 to 0.849) for IVC-CI. The optimal IVC-CI cutoff value was 38.25%, with a sensitivity of 56.7% and specificity of 71.9%. IVC-CI before induction strongly correlated with the maximum percentage of MBP drop after propofol induction. (regression coefficient = 0.33, P = 0.008), respectively.

Conclusion

Pre-induction IVC-CI > 38.25% is a non-invasive predictor of propofol-induced hypotension in patients undergoing colonoscopy and is strongly correlated with MBP drop.

Trial registration

This clinical trial was approved by the Ethics Committee of The Affiliated Lianyungang Hospital of Xuzhou Medical University (YJ-20190529001). All the study procedures were performed in accordance with the ethical standards of the Helsinki Declaration of 2013.

Peer Review reports

Introduction

Propofol is an optimal intravenous anesthetic commonly used for the induction and maintenance of anesthesia [1]. Propofol is a highly efficacious anesthetic with a rapid onset of action and relatively short recovery time. These attributes have led to their selection for anesthesia induction during colonoscopy. In addition, propofol exerts a profound sedative effect and is capable of alleviating anxiety in patients undergoing colonoscopy [2, 3]. Nevertheless, the cardio-vasodilatory effect of propofol may result in hemodynamic instability following induction of hypotension, which is a common adverse event. Potential mechanisms for this include decreased sympathetic tone, reduced preload, and afterload or direct myocardial depression [4]. A previous study showed that the incidence of hypotension following propofol induction was as high as 70% [5].

Hypovolemia is the most likely risk factor for postinduction hypotension; therefore, the identification and management of latent hypovolemia can reduce the incidence of such complications [6]. Although patients with normal cardiorespiratory function and stable hemodynamics can tolerate this side effect, in patients undergoing colonoscopy, preexisting hypovolemia due to dehydration, preoperative fasting and water restriction, bowel preparation, and impaired compensatory responses can exacerbate hypoperfusion of vital organs, which can increase the incidence of propofol-induced hypotension [7, 8]. It is unclear whether a transient decrease in blood pressure following propofol induction affects patient prognosis. However, studies have demonstrated that severe hypotension after induction can result in inadequate organ perfusion and the emergence of adverse postoperative outcomes, including myocardial infarction, acute kidney injury, heart failure, stroke, and prolonged hospitalization with elevated postoperative mortality [9, 10].

Transthoracic echocardiography (TTE) is an important tool for noninvasive hemodynamic monitoring. Measurement of the inferior vena cava (IVC) by TTE provides a cross-sectional image for rapid assessment of intravascular volume status and is commonly used in intensive care units (ICUs) and emergency departments [11]. Several studies have demonstrated that ultrasound measurement of the IVC collapsibility index (IVC-CI) and diameter can be used to assess volume status in perioperative patients [12, 13]. Measurement of the IVC using ultrasound before general anesthesia has been reported to predict hypotension after induction [6, 10]. In 2019, Arican et al. reported a predictive relationship between IVC-CI and fentanyl and propofol-induced hypotension during colonoscopy [14]. Patients with a lower intravascular volume may be more prone to post-induction hypotension (PIH); however, this has not yet been explored. However, in most of these previous studies, combination regimens such as general anesthesia or propofol combined with fentanyl and the simultaneous action of different drugs on the vasculature and heart can complicate the mechanism of PIH. These factors may complicate the predictive value of IVC ultrasonography for PIH. Therefore, this study aimed to assess the predictive value of lower intravascular volume status measured using IVC ultrasonography for propofol-induced hypotension in patients undergoing colonoscopy without other drug side effects.

Materials and methods

Patients

This study was approved by the Ethics Committee of the Affiliated Lianyungang Hospital of Xuzhou Medical University (YJ-20190529001). This study was registered in the Chinese Clinical Trial Registry (ChiCTR1900027052). Before commencement of the study, written informed consent was obtained from all eligible patients. All the study procedures were performed in accordance with the ethical standards of the Helsinki Declaration of 2013.

The inclusion criteria were patients aged between 18 and 65 years without sex restriction and scheduled for colonoscopy, with ASA grades I or II. Before undergoing colonoscopy, patients were required to undergo a basic physical examination. Electrocardiography was required for patients over 40 years of age.

Patients with significant peripheral vascular disease, severe heart valve disease, unstable angina, an ejection fraction < 40%, respiratory distress, increased intra-abdominal pressure, autonomic nervous system disorders, an implanted pacemaker or cardioverter, a mental illness, an emotional or intellectual disability, or who declined to sign the informed consent form were excluded. Patients requiring endoscopic therapy or exhibiting poor IVC visualization, those currently taking angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, and those who underwent colonoscopy for more than 15 min were also excluded. Before commencement of the study, written informed consent was obtained from all eligible patients.

Outcomes

Primary outcome is the correlation of IVC-CI with the occurrence of propofol-induced hypotension during colonoscopy. Secondary outcome is the dIVCmin and dIVCmax.

IVC ultrasonography

The IVC-CI was measured before induction of anesthesia. The IVC-CI was assessed by the same trained anesthesiologist who was blinded to the postinduction hemodynamic measurements. All patients were conscious, supine, and spontaneously breathed for at least 5 min before the IVC examination. An M-mode phased-array transducer (3.5 MHz) of transthoracic echocardiography (Philips CX50; Bothell, WA, USA) was used to measure the IVC diameter and its variation. A micro-convex array transducer was used to identify and measure the maximum diameter of the IVC (dIVCmax) and minimum diameter of the IVC (dIVCmin) during spontaneous breathing, after which the sagittal section of the IVC at the subxiphoid position was scanned. The operator must have a fulcrum on the patient’s skin to ensure that the sonologist remains on the axis. A distance of 2 cm from the junction point of the right atrium and IVC was selected to obtain images of dIVCmax and dIVCmin (including 2–3 breathing cycles). dIVCmax was measured at the end of expiration, whereas dIVCmin was measured at the end of inspiration. Three scans were performed for each patient to ensure the reliability of the IVC measurements. If there was a difference of more than 0.2 cm in the dIVCmax measurements between any two images, the patient’s data were excluded from the study [10, 14]. The entire IVC scan procedure was completed within 10 min. The image deemed to be of highest quality was selected for each patient. The maximum and minimum IVC diameters were measured over a single respiratory cycle using built-in software. CI was calculated as CI = (dIVCmax– dIVCmin)/dIVCmax (Fig. 1) and expressed as a percentage [15, 16]. All hemodynamic and ultrasonographic data were collected by an experienced anesthetist with basic experience in echocardiography who had previously undergone more than 20 IVC ultrasound examinations.

Fig. 1
figure 1

Ultrasound measurements of inferior vena cava (IVC) and calculation of collapsibility index. Panel above shows two-dimensional scan of the IVC, and panel below shows M-mode scan with respiratory variations in diameter. dIVCmax = maximum diameter of IVC; dIVCmax = minimum diameter of IVC

Full size image

Preoperative preparation for colonoscopy

Patients undergoing colonoscopy were required to undergo an 8-hour preoperative fasting from food and then fast from water for 4 h. Additionally, the patients were required to undergo bowel preparation before colonoscopy. It is recommended that patients commence taking compound polyethylene glycol electrolyte powder (PEG) 4–6 h before colonoscopy and finish it within 2 h. If bowel movements fail to meet these criteria, a PEG solution or water may be added, but the total volume should not exceed 4 L. In patients with risk factors for inadequate bowel preparation (e.g. chronic constipation, depression, etc.), a split-dose regimen of PEG may be used to prepare the bowel. The split-dose PEG regimen is routinely used as a 3 L PEG regimen in divided doses, comprising 1 L administered 10–12 h prior to the scheduled bowel examination and 2 L administered 4–6 h prior to the examination on the day of the examination.

Anesthesia management

Upon entering the endoscopy room, vital signs of the patients were recorded. Electrocardiograms, blood pressure (BP) readings, and peripheral oximeter measurements were obtained for all patients. BP was measured using a non-invasive oscillometric cuff. Oxygen was administered via nasal cannula at a flow rate of 4 L/min. Blood pressure was measured using a cuff on three occasions in a resting state, and the readings were averaged to establish the baseline blood pressure. TTE was used to ascertain dIVCmax and dIVCmin. Subsequently, propofol (2.0–3.0 mg/kg) was administered intravenously at a rate of 10 mg every 5 s. The objective of propofol titration for induction is to ensure that the patient exhibits no response to painful stimulation (e.g., squeezing the trapezius). Changes in MBP were measured 1, 3, 5, and 10 min after propofol induction with a cuff. Severe (MBP < 55 mmHg) or prolonged (duration greater than or equal to 2 min) episodes of hypotension were treated with intravenous boluses of norepinephrine (8 ug), if accompanied by a heart rate of less than 50 beats per minute, intravenous boluses of ephedrine (3 mg). A heart rate (HR) < 45 bpm was treated with an intravenous bolus of atropine (0.5 mg).

Data collection

The following demographic data were recorded: age, sex, height, weight, and hypertension history. The current medications used to treat hypertension were also recorded. The average of three MBP readings obtained prior to induction was designated as the baseline. Non-invasive BP and HR were recorded before induction. Non-invasive BP was recorded at 1, 3, 5, and 10 min after propofol induction. The maximum percentage change relative to the baseline value was calculated by using the lowest MBP value after propofol induction. The term “hypotension” was defined as a 20% reduction in MBP or an absolute MBP value < 65 mmHg [17]. Similarly, “severe hypotension” was defined as an MBP value < 55 mmHg [18].

Statistical analysis

Sample size

A review of data from previous relevant studies revealed that IVC-CI had a sensitivity of 78.6% and specificity of 91.7% for predicting the occurrence of post-induction hypotension [19]. A sample size calculation was conducted using the PASS software with a significance level of 0.05, a tolerance error of 0.1, and a two-sided test. This yielded a sample size of 60, which required the inclusion of 60 patients for the analysis.

Data analysis

SPSS version 26.0 (IBM Corporation, Armonk, New, USA York) was used for all statistical analyses. Data collected during the study were compiled using Excel spreadsheets (Microsoft, USA). The normality of the data was tested using the Kolmogorov–Smirnov one-sample test. The data are presented as mean ± standard deviation (SD) for continuous variables and as absolute numbers or percentages for categorical variables. Non-normally distributed measurement data were expressed as medians and interquartile ranges.

The development of clinically significant hypotension after induction was analyzed with respect to patient characteristics, hemodynamic data, and IVC measurements using Student’s t-test or the χ2 test, where appropriate. IVC-CI values were correlated with the percentage of maximum drop in MBP values from baseline after induction of propofol (Pearson correlation). The diagnostic performance of the test was evaluated by examining the specificity, sensitivity, and area under the receiver operating characteristic (ROC) curve. ROC curve analysis was performed to ascertain the capacity of the ultrasound-derived parameter IVC-CI to predict clinically significant hypotension after propofol induction across the entire cohort. AUCs were calculated along with their 95% confidence intervals. The optimal cutoff values were identified as those that maximized the Youden index (sensitivity + specificity − 1) [20]. Sensitivity and specificity with 95% confidence intervals for the optimal cutoff values are presented. A two-tailed p-value of less than 0.05 (two-tailed) was considered statistically significant.

Results

Of the 80 eligible patients, six were excluded due to treatment with ACEIs or ARBs, two refused to participate in the study, and another ten patients (13.9%) were excluded due to poor IVC visualization (Fig. 2). Sixty-two patients completed the study, and their data were considered for statistical analysis Among these, 24 patients had a history of hypertension (Table 1), 10 were taking β-blockers, six were on calcium channel blockers, three were on thiazide diuretics, and three were not on medications.

Fig. 2
figure 2

Flowchart of patients included in the present study

Full size image
Table 1 Comparison of patient characteristics, hemodynamic data, and preoperative inferior vena cava (IVC) ultrasound measurements between patients who did and did not develop hypotension after propofol induction
Full size table

Hemodynamic data

After induction of propofol, 30 (48.7%) patients exhibited a reduction in blood pressure in accordance with the study criteria. Of these, 16 patients exhibited an MBP of less than 65 mmHg. Three patients received noradrenaline and three received ephedrine for severe hypotension lasting more than two minutes. One patient received atropine for bradycardia. There were no significant differences in baseline MBP and HR between patients who developed hypotension and those with more stable blood pressures. Greater IVC-CI was observed in patients who developed hypotension (P < 0.05, Table 1). Increased IVC-CI positively correlated with decreased MBP (r = 0.33; P = 0.008; Fig. 3). No significant difference was observed in the dose of propofol administered to the patients with and without hypotension (P > 0.05, Table 1). A weak association was observed between a decrease in MBP after induction and IVC measurements. The dIVCmin and dIVCmax were not statistically different between the two groups.

Fig. 3
figure 3

Scatter plots showing the relationships of collapsibility index of inferior vena cava with percentage decrease in mean blood pressure from baseline after propofol induction. Trend lines are represented by dotted lines; regression coefficient = 0.33. MBP = mean blood pressure; r = regression coefficient

Full size image

ROC curve analysis for all patients

ROC curve analysis for prediction of hypotension following propofol induction. The optimal cutoff value of IVC-CI was 38.25%, and IVC-CI had an AUC of 0.722 under the ROC curve (95% CI: 0.595–0.849, Table 2). Sensitivity and specificity were 56.7% and 79.1%, respectively (Fig. 4).

Table 2 The performance of IVC-CI as a predictor of hypotension after induction of propofol in patients undergoing colonoscopy
Full size table
Fig. 4
figure 4

Receiver operating characteristic curves showing the ability of collapsibility index of inferior vena cava to predict hypotension after propofol induction

Full size image

Discussions

In patients undergoing colonoscopy after receiving propofol for induction of anesthesia, a pre-induction inferior vena cava collapsibility index > 38.25% can be a simple, non-invasive, and reliable predictor of post-induction hypotension with propofol. IVC-CI before induction strongly correlated with the maximum percentage of MBP drop after propofol induction. After propofol induction, 30 patients (48.7%) exhibited a reduction in blood pressure according to the study criteria.

It has been demonstrated that the IVC is a highly compliant volumetric vessel and that its diameter is a reliable indicator of volume status [21,22,23,24,25]. There is a strong correlation between this diameter and the right atrial pressure and blood volume. Respiratory changes can be utilized to predict fluid responsiveness [26]. During inspiration, a decrease in intrathoracic pressure results in an increase in blood flow from the IVC back to the right atrium, which subsequently leads to a decrease in IVC diameter. Conversely, a decrease in intrathoracic pressure during expiration results in an increase in IVC diameter. A larger IVC-CI is indicative of a hypovolemic state, particularly in the presence of a smaller IVC diameter. The current literature suggests that effective volume resuscitation is associated with a reduction in IVC-CI [27]. IVC diameter is positively correlated with central venous pressure (CVP), whereas IVC-CI is negatively correlated with CVP [28]. The American Society of Echocardiography guidelines recommend the use of ultrasonography to measure the IVC and assess a patient’s volume status [26]. Numerous studies have shown that IVC-CI assesses volume status and is a reliable predictor in patients at a high risk of hypotension [26, 29, 30].

Currently, propofol is one of the most frequently used anesthetic agents for colonoscopies. Nevertheless, propofol is also associated with a few side effects including decreased systemic vascular resistance, sympathetic depression, and decreased cardiac output [31]. The prolonged duration of colonoscopy may necessitate the administration of higher doses of propofol to induce anesthesia. In a Meta-analysis summarizing data from 6 clinical trials of patients undergoing colonoscopy, hypotension was more common with propofol sedation, with an incidence of 35%. Longer propofol sedation and higher propofol doses result in hypotension last longer and more severe hypotension, thus reducing the quality of postoperative recovery and prolonging postoperative recovery time [32]. Therefore, it is of great importance to be able to recognize and predict hypotension after propofol induction at an early stage so that we can intervene in advance to reduce the incidence of hypotension. Therefore, the present study sought to examine the potential of changes in IVC diameter and CI in predicting the occurrence of hypotension after propofol induction.

In this study, there was no significant difference in the maximum and minimum diameters of the veins between patients who developed hypotension and those with a more stable blood pressure. This may be because the absolute value of the diameter of large veins varies considerably between individuals to indicate blood volume status. However, changes in the diameter of large veins reflect not only blood volume status but also blood volume responsiveness. The main reason for propofol-induced hypotension is the relative insufficiency of circulating blood volume due to vasodilatation [33]. This does not necessarily imply absolute volume deficiency. Therefore, there may be no significant difference in absolute IVC diameter.

The use of ultrasonography to evaluate the IVC before induction may assist in identifying of patients who are likely to experience hypotension. Furthermore, this technique can be employed by healthcare providers to inform decisions regarding sedation, propofol dosage, and administration of prophylactic intravenous fluids. Volume assessment represents a fundamental aspect of perioperative therapy in which a range of subsequent treatments is based. Accurate assessment of intravascular volume status and responsiveness can ensure adequate tissue perfusion and improve prognosis. Prolonged fasting and water restriction before colonoscopy can result in volume deprivation, whereas gastrointestinal preparation can further exacerbate hypovolemia. In addition, propofol administration results in vasodilation and myocardial depression, thereby increasing the likelihood of severe hypotension. Therefore, effective blood volume monitoring indicators must be used to predict whether propofol-induced hypotension occurs in patients undergoing colonoscopy. Previous studies have demonstrated that IVC-CI is a non-invasive, simple, rapid, and reliable indicator of intravascular volume status [34, 35]. This study aimed to identify the critical value of IVC-CI by using ROC curves for the prediction of hypotension following propofol-induced hypotension.

A multicenter study showed, ultrasound scanning of the IVC and measurement of the.

IVC-CI preoperatively provides a reliable predictor of hypotension after the induction of general anesthesia in 75% of patients. In patients at a high risk of complications resulting from intraoperative hypovolemia and hypotension, measurement of IVC-CI may provide clinically useful information [10]. Muller et al. showed that patients with IVC-CI ≥ 40% exhibited a heightened risk of developing hypotension following propofol induction. The results of our study indicated that the threshold for predicting propofol-induced hypotension was 38.25%, which was less than the results of the study by Muller et al. Upon analysis of the two studies, it can be postulated that the discrepancy may be attributed to the differing definitions of hypotension [36]. Although intraoperative hypotension is a common side effect of anesthesia, the definition of this phenomenon varies among different clinical studies. Bijker et al. found 140 definitions of hypotension in the literature, which resulted in a wide range of reported incidences [37]. Although there are multiple thresholds defining intraoperative hypotension, two thresholds associated with the prognosis of postoperative myocardial and renal injuries were selected for this study. A drop in blood pressure of > 20% from baseline or a blood pressure of less than 65 mmHg was selected as the definition of hypotension. A previous study also demonstrated that preoperative ultrasound IVC measurements revealed that patients with IVC-CI of greater than 43% were more likely to be hypotensive after the induction of general anesthesia [10]. One distinction is that the distinction of anesthesia was performed with etomidate rather than propofol. Furthermore, the hemodynamic stability of etomidate is well documented. However, propofol is known to cause hypotension following induction owing to vasodilation and myocardial depression [38].

Patients who underwent colonoscopy were selected for this study. Preoperative fasting and bowel preparation had a sufficient effect on the volume of these patients to mimic the status of hypovolemic patients rather than selecting patients with a very poor systemic status. Second, only propofol was administered to patients undergoing colonoscopy at the time of induction, which differs from hypotension induced by intravenous combined anesthesia. In this manner, the interaction with other drugs Is reduced, thereby allowing for a more acute reflection of the occurrence of hypotension following propofol induction. Further experiments could also investigate the incidence of propofol-induced hypotension in patients undergoing colonoscopy after a rapid intravenous infusion strategy before anesthesia induction and further validate the diagnostic value of ultrasound-guided vena cava measurements for PIH with propofol.

This study has the following limitations: First, it included only patients with ASA classes I and II. These patients typically had a good baseline conditions and stable circulatory compensation. In addition, patients with a history of severe respiratory and cardiac diseases were excluded from this study; therefore, the results do not apply to patients with more severe conditions. Second, patients taking ACEIs, or ARBs medications were excluded from the study to avoid their high vasodilatory effect as a confounder; therefore, the results of the current study cannot be applied to such patient populations. Third, ultrasonographic IVC measurements were performed by an operator with basic echocardiographic experience. Nevertheless, the reliability of ultrasound inferior vena cava assessment is not contingent on the operator’s level of echocardiographic experience. It was not within the scope of this study to assess the accuracy of inferior vena cava measurements. A previous study demonstrated moderate interrater reliability of IVC measurements [39]. In addition, the IVC was scanned three times for each patient, and the difference between dIVCmax readings was consistently less than 0.2 cm. Fourth, blood pressure was measured using only the non-invasive oscillometric method, which has a defined time interval for data collection. This may result in the omission of some instances of hypotension, potentially leading to statistical error.

Conclusions

An inferior vena cava collapsibility index > 38.25% before anesthetic induction can be a simple, noninvasive, and reliable predictor of hypotension after propofol induction in patients undergoing colonoscopy. IVC-CI was positively correlated with the maximum decrease in MBP after propofol induction and can be used to guide aspects of preoperative preparation and anesthetic management. Clinically, preoperative IVC-CI measurements are easy and rapid to obtain, and IVC ultrasonography can be integrated into routine clinical practice. However, the study only included patients in good baseline condition, who usually have stable circulatory compensation. Further research is needed to validate these findings in larger, more diverse populations. Future research based on CI measurements is needed to determine the best intravenous fluid strategy to reduce postinduction hypotension.

Data availability

No datasets were generated or analysed during the current study.

Abbreviations

IVC:

Inferior vena cava

IVC-CI:

Inferior vena cava collapsibility index

MBP:

Mean blood pressure

dIVC:

Diameter of the inferior vena cava

dIVCmax:

Maximum IVC diameter

dIVCmin:

Minimum IVC diameter

ASA:

American Society of Anesthesiologists physical status

TTE:

Transthoracic echocardiography

ICUs:

Intensive care units

ACEIs:

Angiotensin-converting enzyme inhibitors

ARBs:

Angiotensin receptor blockers

PIH:

Post-induction hypotension

PEG:

Polyethylene glycol electrolyte powder

BP:

Blood pressure

HR:

Heart rate

CVP:

Central venous pressure

ROC:

Receiver operating characteristic

AUC:

Area under curve

References

  1. Ghojazadeh M, Sanaie S, Paknezhad SP, Faghih S-S, Soleimanpour H. Using ketamine and propofol for procedural sedation of adults in the Emergency Department: a systematic review and Meta-analysis. Adv Pharm Bull. 2019;9:5–11.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  2. Korman LY, Haddad NG, Metz DC, Brandt LJ, Benjamin SB, Lazerow SK, et al. Effect of propofol anesthesia on force application during colonoscopy. Gastrointest Endosc. 2014;79:657–62.

    Article  PubMed  Google Scholar 

  3. McQuaid KR, Laine L. A systematic review and meta-analysis of randomized, controlled trials of moderate sedation for routine endoscopic procedures. Gastrointest Endosc. 2008;67:910–23.

    Article  PubMed  Google Scholar 

  4. Saugel B, Bebert E-J, Briesenick L, Hoppe P, Greiwe G, Yang D, et al. Mechanisms contributing to hypotension after anesthetic induction with sufentanil, propofol, and rocuronium: a prospective observational study. J Clin Monit Comput. 2022;36:341–7.

    Article  PubMed  Google Scholar 

  5. Takaki R, Yokose M, Mihara T, Saigusa Y, Tanaka H, Yamamoto N, et al. Hypotension after general anaesthesia induction using remimazolam or propofol in geriatric patients undergoing sevoflurane anaesthesia with remifentanil: a single-centre, double-blind, randomised controlled trial. Br J Anaesth. 2024;133:24–32.

    Article  PubMed  CAS  Google Scholar 

  6. Szabó M, Bozó A, Darvas K, Horváth A, Iványi ZD. Role of inferior vena cava collapsibility index in the prediction of hypotension associated with general anesthesia: an observational study. BMC Anesthesiol. 2019;19:139.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Cheng Z, Yang Q, Zhu P, Feng J, Zhang X, Zhao Z. Transesophageal echocardiographic measurements of the Superior Vena Cava for Predicting Fluid responsiveness in patients undergoing invasive positive pressure ventilation. J Ultrasound Med. 2019;38:1519–25.

    Article  PubMed  Google Scholar 

  8. Jor O, Maca J, Koutna J, Gemrotova M, Vymazal T, Litschmannova M, et al. Hypotension after induction of general anesthesia: occurrence, risk factors, and therapy. A prospective multicentre observational study. J Anesth. 2018;32:673–80.

    Article  PubMed  Google Scholar 

  9. Wesselink EM, Kappen TH, Torn HM, Slooter AJC, Van Klei WA. Intraoperative hypotension and the risk of postoperative adverse outcomes: a systematic review. Br J Anaesth. 2018;121:706–21.

    Article  PubMed  CAS  Google Scholar 

  10. Zhang J, Critchley LAH. Inferior Vena Cava Ultrasonography before General Anesthesia can predict hypotension after induction. Anesthesiology. 2016;124:580–9.

    Article  PubMed  CAS  Google Scholar 

  11. Ghobrial BB, Alansary AM, Aly RM, Bayoumy AM. Ultrasound Measurement of Inferior Vena Cava Diameter versus Central venous pressure as a Tool of Assessment of Intravascular volume in adult ICU patients. QJM: Int J Med. 2020;113 Supplement_1:hcaa039.044.

  12. Zhang Z, Xu X, Ye S, Xu L. Ultrasonographic Measurement of the respiratory variation in the Inferior Vena Cava Diameter is Predictive of Fluid responsiveness in critically ill patients: systematic review and Meta-analysis. Ultrasound Med Biol. 2014;40:845–53.

    Article  PubMed  Google Scholar 

  13. Zhang X, Feng J, Zhu P, Luan H, Wu Y, Zhao Z. Ultrasonographic measurements of the inferior vena cava variation as a predictor of fluid responsiveness in patients undergoing anesthesia for surgery. J Surg Res. 2016;204:118–22.

    Article  PubMed  Google Scholar 

  14. Arican Ş, Dertli R, Dağli Ç, et al. The role of right ventricular volumes and inferior vena cava diameters in the evaluation of volume status before colonoscopy. Turk J Med Sci. 2019;49:1606–13.

    PubMed  PubMed Central  Google Scholar 

  15. Nagdev AD, Merchant RC, Tirado-Gonzalez A, Sisson CA, Murphy MC. Emergency Department Bedside Ultrasonographic Measurement of the Caval Index for Noninvasive determination of low central venous pressure. Ann Emerg Med. 2010;55:290–5.

    Article  PubMed  Google Scholar 

  16. Aslan N, Yildizdas D, Horoz OO, Coban Y, Arslan D, Sertdemir Y. Central venous pressure, global end-diastolic index, and the inferior vena cava collapsibility/distensibility indices to estimate intravascular volume status in critically ill children: a pilot study. Australian Crit Care. 2021;34:241–5.

    Article  Google Scholar 

  17. Wickham AJ, Highton DT, Clark S, Fallaha D, Wong DJN, Martin DS, et al. Treatment threshold for intra-operative hypotension in clinical practice—a prospective cohort study in older patients in the UK. Anaesthesia. 2022;77:153–63.

    Article  PubMed  CAS  Google Scholar 

  18. Mehandale S, Rajasekhar P. Perfusion index as a predictor of hypotension following propofol induction - A prospective observational study. Indian J Anaesth. 2017;61:990.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Zhang H, Gao H, Xiang Y, Li J. Maximum inferior vena cava diameter predicts post-induction hypotension in hypertensive patients undergoing non-cardiac surgery under general anesthesia: a prospective cohort study. Front Cardiovasc Med. 2022;9:958259.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Hajian-Tilaki K. The choice of methods in determining the optimal cut-off value for quantitative diagnostic test evaluation. Stat Methods Med Res. 2018;27:2374–83.

    Article  PubMed  Google Scholar 

  21. Brennan JM, Blair JE, Goonewardena S, Ronan A, Shah D, Vasaiwala S, et al. Reappraisal of the Use of Inferior Vena Cava for estimating right atrial pressure. J Am Soc Echocardiogr. 2007;20:857–61.

    Article  PubMed  Google Scholar 

  22. Ivey-Miranda JB, Wetterling F, Gaul R, Sheridan S, Asher JL, Rao VS, et al. Changes in inferior vena cava area represent a more sensitive metric than changes in filling pressures during experimental manipulation of intravascular volume and tone. Eur J Heart Fail. 2022;24:455–62.

    Article  PubMed  CAS  Google Scholar 

  23. Chou Y-Y, Ward JL, Barron LZ, Murphy SD, Tropf MA, Lisciandro GR, et al. Focused ultrasound of the caudal vena cava in dogs with cavitary effusions or congestive heart failure: a prospective, observational study. PLoS ONE. 2021;16:e0252544.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  24. Elbanna MM, Boulos Ghobrial B, Nofal WH, Nassif GM. Inferior Vena Cava Collapsibility Index vs Central venous pressure for Assessment of Intravascular volume status in patients with ischemic Heart diseases. QJM: Int J Med. 2024;117 Supplement_2:hcae175.069.

  25. Rudski LG, Lai WW, Afilalo J, Hua L, Handschumacher MD, Chandrasekaran K, et al. Guidelines for the echocardiographic Assessment of the right heart in adults: a report from the American Society of Echocardiography. J Am Soc Echocardiogr. 2010;23:685–713.

    Article  PubMed  Google Scholar 

  26. Zengin S, Al B, Genc S, Yildirim C, Ercan S, Dogan M, et al. Role of inferior vena cava and right ventricular diameter in assessment of volume status: a comparative study. Am J Emerg Med. 2013;31:763–7.

    Article  PubMed  Google Scholar 

  27. Stawicki S, Kent A, Patil P, Jones C, Stoltzfus J, Vira A, et al. Dynamic behavior of venous collapsibility and central venous pressure during standardized crystalloid bolus: a prospective, observational, pilot study. Int J Crit Illn Inj Sci. 2015;5:80.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Vaish H, Kumar V, Anand R, Chhapola V, Kanwal SK. The correlation between Inferior Vena Cava Diameter measured by Ultrasonography and central venous pressure. Indian J Pediatr. 2017;84:757–62.

    Article  PubMed  Google Scholar 

  29. Dana E, Dana HK, De Castro C, Bueno Rey L, Li Q, Tomlinson G, et al. Inferior vena cava ultrasound to predict hypotension after general anesthesia induction: a systematic review and meta-analysis of observational studies. Can J Anesth/J Can Anesth. 2024;71:1078–91.

    Article  Google Scholar 

  30. Boles Ghobrial B, Labib HAA, Mohamed MS, Sayed Yassen AAE-R. Ultrasound guided Preoperative Assessment of Inferior Vena Cava Collapsibility Index in Prediction of Intraoperative Hypotension in patients undergoing laparoscopic cholecystectomy surgery under General Anesthesia. QJM: Int J Med. 2023;116(Supplement_1):hcad069–022.

  31. Ebert TJ. Sympathetic and hemodynamic effects of Moderate and Deep Sedation with Propofol in humans. Anesthesiology. 2005;103:20–4.

    Article  PubMed  CAS  Google Scholar 

  32. Sneyd JR, Absalom AR, Barends CRM, Jones JB. Hypotension during propofol sedation for colonoscopy: a retrospective exploratory analysis and meta-analysis. Br J Anaesth. 2022;128:610–22.

    Article  PubMed  CAS  Google Scholar 

  33. Royse CF, Liew DFL, Wright CE, Royse AG, Angus JA. Persistent depression of Contractility and Vasodilation with Propofol but not with sevoflurane or desflurane in rabbits. Anesthesiology. 2008;108:87–93.

    Article  PubMed  CAS  Google Scholar 

  34. Li Y, Cen Y. The Diagnostic Value of Ultrasonic Measurement of Inferior Vena Cava Diameter Respiratory variability on volume response evaluation of geriatric hip fracture. Prehosp Disaster med. 2019;34:s120–1.

    Article  Google Scholar 

  35. Kumar A, Kumar S, Kumar A, Bharti AK, Hussain M. Correlation of Internal Jugular Vein and Inferior Vena Cava Collapsibility Index with Direct Central venous pressure measurement in critically-ill patients: an observational study. Indian J Crit Care Med. 2024;28:595–600.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Muller L, Bobbia X, Toumi M, Louart G, Molinari N, Ragonnet B, et al. Respiratory variations of inferior vena cava diameter to predict fluid responsiveness in spontaneously breathing patients with acute circulatory failure: need for a cautious use. Crit Care. 2012;16:R188.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Bijker JB, Van Klei WA, Kappen TH, Van Wolfswinkel L, Moons KGM, Kalkman CJ. Incidence of Intraoperative Hypotension as a function of the Chosen Definition. Anesthesiology. 2007;107:213–20.

    Article  PubMed  Google Scholar 

  38. Lima EQ, Zanetta DMT, Castro I, Massarollo PCB, Mies S, Machado MM, et al. Risk factors for development of Acute Renal failure after liver transplantation. Ren Fail. 2003;25:553–60.

    Article  PubMed  Google Scholar 

  39. Seif D, Mailhot T, Perera P, Mandavia D. Caval Sonography in shock: a noninvasive method for evaluating intravascular volume in critically ill patients. J Ultrasound Med. 2012;31:1885–90.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

We would like to thank all the anesthetists in our department who participated in this work.

Funding

This research was supported by The Lianyungang Science and Technology Project (JCYJ2305), Lianyungang 521 project, and the Clinical Research Fund of the Affiliated Lianyungang Hospital of Xuzhou Medical University (LC13).

Author information

Author notes

  1. Zhou Zhou, Yujie Li and Jinxian Zhu contributed equally to this work.

Authors and Affiliations

  1. Department of Anesthesiology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, China

    Zhou Zhou, Yujie Li, Xiaoqiao Sang, Xinxin Wang & Xiaobao Zhang

  2. Lianyungang Maternal and Child Health Hospital, Lianyungang, China

    Jinxian Zhu

  3. Department of Anesthesiology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China

    Yingge Liu

  4. Department of Anesthesiology, Lianyungang Clinical College of Nanjing Medical University, Lianyungang, China

    Yuxin Wang

  5. Department of Anesthesiology, The First Affiliated Hospital of Kangda College of Nanjing Medical University, Lianyungang, China

    Xiaobao Zhang

Authors
  1. Zhou Zhou
    View author publications

    You can also search for this author inPubMed Google Scholar

  2. Yujie Li
    View author publications

    You can also search for this author inPubMed Google Scholar

  3. Jinxian Zhu
    View author publications

    You can also search for this author inPubMed Google Scholar

  4. Yingge Liu
    View author publications

    You can also search for this author inPubMed Google Scholar

  5. Yuxin Wang
    View author publications

    You can also search for this author inPubMed Google Scholar

  6. Xiaoqiao Sang
    View author publications

    You can also search for this author inPubMed Google Scholar

  7. Xinxin Wang
    View author publications

    You can also search for this author inPubMed Google Scholar

  8. Xiaobao Zhang
    View author publications

    You can also search for this author inPubMed Google Scholar

Contributions

All authors reviewed and approved the final manuscript. ZZ registered, collected, and analyzed the data and wrote the main manuscript text. LYJ and ZJX collected data, helped with the design of the study and wrote the abstract. LYG, WYX, WXX, and SXQ prepared the tables and figures, helped with the study design, wrote the review, and edited the manuscript. ZXB supervised the study, analyzed the data, and helped with the study design.

Corresponding author

Correspondence to Xiaobao Zhang.

Ethics declarations

Ethics approval and consent to participate

This study was approved by the Ethics Committee of the Affiliated Lianyungang Hospital of Xuzhou Medical University (YJ-20190529001). This study was registered in the Chinese Clinical Trial Registry (ChiCTR1900027052). Prior to the commencement of the study, written informed consent was obtained from all eligible patients. All the study procedures were performed in accordance with the ethical standards of the Helsinki Declaration of 2013.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.

Writing process

Authors did not use AI in the writing process of this research.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Zhou, Z., Li, Y., Zhu, J. et al. Role of the inferior vena cava collapsibility index in predicting propofol-induced hypotension in patients undergoing colonoscopy. BMC Anesthesiol 25, 73 (2025). https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s12871-025-02945-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s12871-025-02945-y

Keywords

BMC Anesthesiology

ISSN: 1471-2253

Contact us