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Preoperative corrected carotid flow time is associated with spinal anesthesia-induced hypotension in hypertensive
Mahmut Sami Tutar1, Hasan Alp Mermer1, Ali Aydin Oner1
1Department of Anesthesiology and Reanimation, Konya City Hospital, University of Health Sciences, Turkey.
Background:
Spinal anesthesia-induced hypotension (SAIH) is common in hypertensive patients, yet reliable preoperative markers remain limited. Corrected carotid flow time (CCFT) is a Doppler-derived index influenced by preload and ventricular ejection timing, but its association with SAIH in this population has not been established.
Objective:
To evaluate whether preoperative CCFT is independently associated with SAIH in hypertensive patients undergoing spinal anesthesia.
Design:
Single-center prospective observational study.
Patients:
In total, 110 hypertensive adults scheduled for lower abdominal or lower extremity surgery under spinal anesthesia.
Setting:
University hospital, operating room.
Interventions:
Preoperative carotid and brachial ultrasound assessments (CCFT, carotid intima-media thickness (CIMT), flow-mediated dilation (FMD), carotid blood flow, and internal jugular vein collapsibility index) were performed. Hemodynamics were recorded for 30 min after spinal injection.
Main Outcome Measures:
Primary outcome: SAIH (≥20% decrease in systolic blood pressure or SBP <90 mmHg sustained for ≥1 minute).
Secondary Outcomes:
hemodynamic trends and discriminative performance of ultrasound parameters.
Results:
SAIH occurred in 54 patients (49.1%). CCFT was shorter in patients who developed hypotension (326.5 ± 71.3 vs 437.3 ± 82.9 ms, p < 0.001). In the primary multivariable model including CIMT, FMD, and beta-blocker use, CCFT remained independently associated with SAIH (adjusted odds ratio 0.980 per 1-ms increase, 95% confidence interval (CI) 0.973-0.988, p < 0.001). CCFT alone had an area under the curve (AUC) of 0.854 (95% CI 0.785-0.924); the 358.5-ms cut-off had 74.1% sensitivity and 87.5% specificity. A clinical model including age, baseline SBP, and beta-blocker use had an AUC of 0.572 (95% CI 0.465-0.679); adding CCFT increased the AUC to 0.866 (95% CI 0.799-0.932; paired comparison p < 0.001).
Conclusions:
Preoperative CCFT was independently associated with SAIH and improved discrimination when added to a parsimonious clinical model. The cohort-derived threshold requires external validation before clinical implementation.
Trial Registration:
ClinicalTrials.gov (https://clinicaltrials.gov/), NCT06749184.
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