How frequently have you observed this phenomena ?
Is this rather rare or maybe quite common ?
Has there been any research done investigating this specific circumstance ?
We are currently investigating the correlation between ultrasound of the inferior vena cava during haemodialysis at three time points (start/middle/cessation) in comparison with simultaneous blood pressure readings and predialytic bioimpedance measurements.
This finding is quite commonly seen in my practice of anesthesia (preoperatively). Once general anesthesia is induced, the resulting hypotension can be quite alarming. A vasopressor is needed in nearly every case.
Regards,
Christopher
Kalainy, S., Reid, R., Jindal, K., Pannu, N., & Braam, B. (2015). Fluid volume expansion and depletion in hemodialysis patients lack association with clinical parameters. Canadian journal of kidney health and disease, 2(1), 54.
Ren, X., Williams, S., Flint, A., Feldman, C., Windust, S., Schiller, N., & Lingamneni, R. (2014). Echocardiographic Assessment of Volume Status in Hemodialysis Patients: a Study Based on Inferior Vena Cava Diameter and Ventricular Interdependence.
As Dr Smith has said above,this is a very common issue.
Patients on maintenance haemodialysis,especially those who are oligo-anuric,oscillate between being effectively underfilled post dialysis,and over filled when approaching dialysis,and are very often concurrently hypertensive.
The hypotension following induction of general anaesthesia in that group of patients can be both marked and rapid.
Clearly,volume expansion is not an easy option in anuric haemodialysis patients,and use of vasoconstrictors such as metaraminol or phenylephrine is often required.
Best regards,
Ian
this is a good idea to conduct the correlation analysis.
other factors should be taken into consideration such as that the diagnostic performance of IVC is not accurate, especially in patients undergoing spontaneous breathing. There is evidence that controlled mechanical ventilation could improve the diagnostic accuracy.
Preload is only one of 3 determinants of cardiac output (CO) and CO is one of two determinants of the blood pressure. Each determinant can compensate the another one. BP is determinated by preload, heart frequency and afterload with one of its components - systemic vascular resistance. We should maintain normal preload to prevent futher renal damage and concurrently maintain relatively normal systemic vascular resistence by using vasodilatators. Bad approach is to treat the hypertension using forced dialysis and negative fluid balance.