Abstract: Objective To evaluate the accuracy and feasibility of variation of internal jugular vein respiration (VIJV) in evaluating the volume responsiveness of patients undergoing gastrointestinal surgery. Methods Patients who underwent elective gastrointestinal surgery under general anesthesia, with American Society of Anesthesiologists (ASA) Ⅰ or Ⅱ, heart function Ⅰ, aging 42-74, body mass index (BMI)<25 kg/m2, were infused with 6% hydroxyethyl starch 130/0.4 NaCl injection (7 ml/kg) at a rate of 0.4 ml·kg-1·min-1 after anesthesia induction. Patients before volume expansion were classified as responders or non-responders according to the increases in the stroke volume variability (SVV) (≥13% or not). The responders were thought with relatively insufficient volume, and the others were thought with sufficient volume. Sixty patients were enrolled in this study. Thirty one patients were defined as responders and the rest twenty nine were defined as non-responders. Their hemodynamic parameters (heart rate, SVV, CVP, MAP) were recorded before and 3 min after volume expanding. The diameter of the internal jugular vein and inner diameter of inferior vena cava in the end of inspiratory by ultrasonic instrument, variation of internal jugular vein respiration (VIJV) and variation of inferior vena cava respiration (VIVC) were calculated, and the ultrasonic measurement time was recorded. The VIJV, VIVC and SVV were used for Pearson′s correlation analysis, and receiver operating characteristic curve (ROC) was plotted. Results There was no statistical difference in basic information between the two groups (P>0.05). After volume expanding, the responder group showed remarkable decreases in heart rate and SVV, and marked increases in central venous pressure (CVP) and mean arterial pressure (MAP) (P<0.05), and the non-responder group showed increased CVP (P<0.05). Compared with before expansion, both groups demonstrated reduced VIJV and VIVC after volume expanding, with shortened VIJV ultrasonic measurement time (P<0.05). Meanwhile, VIJV and VIVC were positively correlated with SVV (P<0.05). The areas under ROC curve (AUC) of VIJV and VIVC were 0.829 and 0.928, and the cut off was 18.9% and 19.7%, respectively. Conclusions The value of VIJV≥18.9% during abdominal surgery can be used to effectively evaluate intraoperative patient volume reactivity, with a sensitivity of 93.3% and a specificity of 73.3%. It can be used as an alternative index of VIVC.
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