Predicting post-spinal anesthesia hypotension with (cardio)vascular ultrasound

Dear Editor, The article by Eeshwar et al. on the prediction of post-spinal anesthesia hypotension (PSAH) with inferior vena cava collapsibility index and caval aorta index is a welcome inclusion to the hemodynamic role of perioperative ultrasonography.[1,2] Nonetheless, it should be emphasized that beyond the volume status, there might be other important factors associated with PSAH. Appropriate to the context, an observational mechanistic study by Jakobsson et al.[3] signify PSAH to be a consequence of compromised cardiac function in the elderly. Indeed, the Eeshwar et al.[1] study outlined advanced age as an independent risk for PSAH, not to however undermine their inability to involve a sample size large enough to ensure equidistribution between the age groups. Albeit having included ≥65-year-old patients as opposed to a wider range of 18–65-year-old participants in the index study, it was only very recently that Park et al.[4] highlighted the role of preoperative echocardiography within the scope of ultrasonography-based prediction of PSAH.[1,4] The research group concluded preoperative mitral inflow E velocity on Doppler ultrasound to be an independent predictor of PSAH (odds ratio: 0.886; 95% confidence interval: 0.845–0.929, P < 0.001), bespeaking the implications of left ventricular (LV) diastolic dysfunction in elective surgical patients receiving spinal anesthesia, only having happened to have excluded ≥grade II LV diastolic dysfunction. To conclude, LV diastolic function should thus be duly assessed alongside systolic function while predicting PSAH with cardiovascular ultrasound ahead of cardiac or, for that matter, an isolated vascular ultrasound, as in this case.[1-4] Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.