Oturur Pozisyon Öncesinde Pletismografik Değişkenlik İndeksi ve Vena Kava İnferior Çapı Ölçümleri ile Volüm Durumunun Değerlendirilmesi

• Published in: Anestezi dergisi Vol. 32; no. 3; pp. 174 - 181
• Main Authors: Namli Emlek, Merve, Donmez, Asli, Polat, Reyhan
• Format: Journal Article
• Language: English
• Published: 29-07-2024
• DOI: 10.54875/jarss.2024.23500
• EISSN: 2687-2242
• ISSN: 1300-0578

Objective: Orthostatic hypotension is a frequently encountered problem after sitting position. The aim of our study was to evaluate the intravascular volume status with passive leg-raising maneuver (PLRM), vena cava inferior (VCI) diameter measurements and plethysmographic variability index- plethysmographic waveform amplitude (∆Ppleth) before sitting position and to investigate the effect of these on predicting hemodynamic changes that may develop after sitting position. Methods: Fifty-three patients undergoing arthroscopic shoulder surgery under general anesthesia, aged 18-65, ASA I-II, were included in this prospective study. Mechanical ventilation was commenced with tidal volume of 6-8 mL kg-1, 5 cm H2O of PEEP. Heart rates, blood pressure and manually measured plethysmographic waveform amplitudes were recorded and VCI-distensibility index (VCI-DI) was calculated. Measurements were repeated after performing PLRM. Correlation of hemodynamic changes, observed after patients were placed in sitting position, with VCI-DI and variations in the ∆Ppleth was evaluated. Results: After induction, VCI-DI was >18% in 19 (35.8%) of 53 patients and in 14 (73.7%) of these, VCI-DI decreased with PLRM. In 14 (93.3%) of 15 patients with ∆Ppleth >15% after induction, ∆Ppleth decreased after PLRM. The decrease in VCI-DI and ∆Ppleth with PLRM was statistically significant (p<0.001; p<0.001). Changes in VCI-DI were found to correlate with ∆Ppleth (p<0.001). When patients were placed in sitting position, there was a significant decrease in heart rate, systolic blood pressure, mean arterial pressure (p=0.031; p<0.001), and a significant increase in ∆Ppleth (p<0.001). Conclusion: Plethysmographic waveform amplitude after PLRM can be used to predict the volume status and hemodynamic response of patients undergoing shoulder surgery in sitting position. Keywords: Fluid responsiveness, inferior vena cava diameter, passive leg raise, plethysmography, sitting position