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Fluid responsiveness and hypotension in patients undergoing propofol-based sedation for colonoscopy following bowel preparation: a prospective cohort study

  • 0Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Melbourne, VIC, Australia. megan.allen@mh.org.au.
Canadian Journal of Anaesthesia = Journal Canadien D'anesthésie +

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April 11, 2025

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April 11, 2025

View abstract on PubMed

Summary

This summary is machine-generated.

Patients undergoing colonoscopy often experience fluid depletion, increasing hypotension risk. Transthoracic echocardiography (TTE) is more reliable than ClearSight monitoring for assessing volume status.

Area Of Science

  • Cardiology
  • Gastroenterology
  • Anesthesiology

Background

  • Fasting and bowel preparation can lead to intravascular volume depletion in patients undergoing colonoscopy.
  • Clinical consequences and rigorous demonstration of volume depletion are often lacking.
  • This study investigates volume status and its relation to intraprocedural hypotension during colonoscopy.

Purpose Of The Study

  • To explore the relationship between intravascular volume status and intraprocedural hypotension.
  • To compare transthoracic echocardiography (TTE) and ClearSight™ noninvasive cardiac output monitor in assessing intravascular volume status.
  • To determine the incidence of fluid responsiveness in patients undergoing colonoscopy.

Main Methods

  • Adult patients undergoing elective colonoscopy were recruited.
  • Volume status was assessed preprocedure using TTE and ClearSight measurements.
  • Intraprocedural hypotension was defined as mean arterial pressure < 60 mm Hg; primary outcome was volume depletion via TTE passive leg raise test.

Main Results

  • 32% of patients with adequate TTE images showed signs of volume depletion.
  • There was poor agreement between TTE and ClearSight for stroke volume measurements.
  • Fluid-responsive patients had a higher incidence of significant intraprocedural hypotension (48%) compared to normovolemic patients (21%).

Conclusions

  • Patients undergoing colonoscopy after bowel preparation are frequently fluid responsive.
  • Fluid-responsive patients are at higher risk for significant intraprocedural hypotension.
  • Transthoracic echocardiography remains a more reliable method for assessing volume status than ClearSight monitoring.

Keywords:

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