Predicting Post-Spinal Anesthesia Hypotension in Geriatric Patients: A Narrative Review of Ultrasonographic Carotid Flow Time and Inferior Vena Cava Collapsibility Index

Post-spinal anesthesia hypotension (PSAH) remains a frequent and potentially severe complication, particularly in geriatric patients who possess limited physiological reserves. Accurate prediction of PSAH is crucial for timely intervention and improved patient outcomes. This narrative review synthesizes current evidence regarding the efficacy of two non-invasive ultrasonographic indices—corrected carotid flow time (CFTc) and inferior vena cava collapsibility index (IVCCI)—in predicting PSAH in the elderly. The review highlights a recent prospective observational study on 282 geriatric patients undergoing elective surgeries, which found that neither CFTc (AUC 0.506, p=0.902) nor IVCCI (AUC 0.515, p=0.737) independently served as reliable predictors of PSAH. This finding is consistent with several other studies in geriatric or specific patient populations, suggesting limitations of these indices in complex hemodynamic scenarios. Conversely, some meta-analyses and studies in younger cohorts indicate better predictive value, underscoring the influence of patient demographics and physiological context. The review discusses the unique hemodynamic challenges in older adults that may diminish the predictive accuracy of these tools and emphasizes the need for comprehensive, multifactorial risk assessment. Future research should focus on integrating multiple parameters and advanced predictive models to enhance PSAH prediction and ultimately improve safety for geriatric patients undergoing spinal anesthesia.