Dynamic changes in the internal jugular vein during supine and passive leg raising as predictors of spinal anesthesia-induced hypotension in the elderly: A prospective diagnostic accuracy study.

BACKGROUND

Spinal anaesthesia-induced hypotension is common in elderly patients and is associated with serious complications, including myocardial ischaemia, arrhythmias, acute heart failure, stroke, kidney injury, and, in rare cases, perioperative blindness. Reliable predictors are needed to identify vulnerable patients before anaesthesia induction. This study evaluated whether dynamic changes in internal jugular vein diameter between supine and passive leg raising could predict spinal anaesthesia-induced hypotension in elderly patients.

METHODS

This prospective study was conducted at Cairo University Hospitals after ethics approval and trial registration. Patients older than 65 years, classified as American Society of Anesthesiologists physical status I-II, scheduled for elective infraumbilical surgery under spinal anaesthesia, were enrolled. Exclusion criteria included obesity, uncontrolled hypertension, reduced cardiac function, emergency surgery, and contraindication for spinal anaesthesia. Baseline haemodynamics were recorded supine. Internal jugular vein diameter and cross‑sectional area were measured by ultrasound in supine and passive leg raising positions. Spinal anaesthesia was performed with hyperbaric bupivacaine and fentanyl. Hypotension was defined as mean arterial pressure less than 65 mmHg or >20% lower than baseline. Receiver operating characteristic analysis was used to evaluate predictive accuracy.

RESULTS

Data from 70 of the 92 patients screened were included in the final analysis. Spinal anaesthesia-induced hypotension occurred in 42 patients (60%), with severe hypotension in 7 patients (10%). Patients who developed hypotension showed significantly greater reductions in mean arterial pressure compared with stable patients. Percentage changes in internal jugular vein diameter and cross‑sectional area between supine and passive leg raising were significantly higher in hypotensive patients (P < .001). Receiver operating characteristic analysis demonstrated excellent predictive accuracy: >11% change in diameter yielded an area under the curve of 1.00 with 100% sensitivity and specificity, while >21.5% change in cross‑sectional area achieved an area under the curve of 0.99 with 100% sensitivity and 93% specificity. Static measurements alone had poor predictive value.

CONCLUSION

Dynamic changes in internal jugular vein diameter and cross‑sectional area during passive leg raising are reliable, noninvasive predictors of spinal anaesthesia-induced hypotension in elderly patients. Incorporating internal jugular vein ultrasonography into routine preoperative assessment may improve risk stratification and guide preventive strategies. Larger multicentre studies are needed to confirm these findings and evaluate their impact on clinical outcomes.