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The predictive role of carotid artery flow time for anesthesia-induced hypotension in high-risk elderly patients

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Abstract

Hypotension induced by general anesthesia is associated with postoperative complications, increased mortality, and morbidity, particularly elderly patients. The aim of this study was to investigate the effectiveness of corrected carotid artery flow time (FTc) for predicting hypotension following anesthesia induction in patients over 65 years old. After faculty ethical committee approval and written informed consent, 138 patients (65 years and older, ASA physical status I–III) who scheduled for elective surgery were included in this study. In the pre-operative anesthesia unit, the carotid artery FTc value was measured by ultrasound and hemodynamic values were recorded. Following anesthesia induction with propofol, hemodynamic data were recorded at 1-minute intervals for 3 min. Measurements were terminated prior to endotracheal intubation, as direct laryngoscopy and endotracheal intubation could cause sympathetic stimulation and hemodynamic changes. Hypotension occurred in 52 patients (37.7%). The preoperative FTc value of the patients who developed hypotension was statistically lower (312.5 ms) than the patients who did not (345.0 ms) (p < 0.001). The area under the ROC curve for carotid artery FTc was 0.93 (95% CI for AUC:0.89–0.97; p < 0.001) with an optimal cut-off of value for predicting post-anesthesia hypotension 333 ms, a sensitivity of 90.4% and a specificity of 84.9%. As a result of the multiple logistic regression model, carotid artery FTc emerged as the sole independent risk factor for hypotension following anesthesia induction. Preoperative carotid artery FTc measurement is a simple, bedside, noninvasive, and reliable method for predicting anesthesia-induced hypotension in elderly patients. 

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Acknowledgements

Assistance with the special article: the authors would like to thank to True Editors Customer Service (order 4458) for English editing of this study.

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Authors and Affiliations

  1. Department of Anesthesiology and Reanimation, Cukurova University, Adana, Turkey

    Ismail Demir, Mediha Turktan, Ersel Gulec & Mehmet Ozalevli

  2. Department of Biostatistic, Cukurova University, Adana, Turkey

    Yusuf Kemal Arslan

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  1. Ismail Demir
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  2. Mediha Turktan
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by ID, MT, EG, YKA, and MO. The first draft of the manuscript was written by ID and MT, all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Mediha Turktan.

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Competing interests

The authors have no relevant financial or non-financial interests to disclose.

Ethical approval

This study was performed in line with the principles of the Declaration of Helsinki. The approval for this study was obtained from the institutional review board of Cukurova University Ethics Committee (Date: Jan/06/2023, IRB number: 129/10).

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Our study did NOT use any diagnostic images (x-rays, laparoscopic images, ultrasound images, brain scans, pathology slides, etc.) or any part of the participants' bodies.

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Demir, I., Turktan, M., Gulec, E. et al. The predictive role of carotid artery flow time for anesthesia-induced hypotension in high-risk elderly patients. J Clin Monit Comput (2024). https://doi.org/10.1007/s10877-024-01145-2

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