Raoul Schorer et al.
Anesthesia & Analgesia, July 2025
In this systematic review and Bayesian network meta-analysis, 32 studies involving 2631 adult surgical patients were analyzed to evaluate the effectiveness of point-of-care ultrasound (POCUS) in predicting postinduction hypotension (PIH). Of the 26 studies included in the meta-analysis, the most frequently studied test—the inferior vena cava collapsibility index—had a sensitivity of 60% and specificity of 83%. Carotid artery corrected flow time showed the highest predictive value with 91% sensitivity and 90% specificity, though based on only two studies. Despite some promising metrics, most studies had significant limitations, including selection bias, lack of blinding, and inconsistent PIH definitions. Consequently, the certainty of evidence was rated very low for all ultrasound modalities examined. The authors call for high-quality randomized trials to establish the clinical utility of POCUS in predicting PIH.
Reference: Schorer R, Ibsen A, Hagerman A, Ellenberger C, Putzu A. Anesthesia & Analgesia. 2025 Jul;141(1):26-37. doi:10.1213/ANE.0000000000007108
KEY POINTS
Question: What is the predictive power of point-of-care ultrasound tests for post anesthesia induction hypotension?
Findings: The currently available literature does not allow firm conclusions about the prediction performance of point-of-care ultrasound tests for post anesthesia induction hypotension.
Meaning: There is a need for high-quality randomized controlled trials with appropriate blinding and void of selection bias. Evaluation of both left ventricle preload and afterload is a possible avenue for expanding the use of point-of-care ultrasonography (POCUS) in postinduction hypotension (PIH) prediction.
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