الفهرس 
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Abstract
Laparoscopic surgery aims to minimize trauma of the interventional process but still achieve a satisfactory therapeutic results. It is commonly performed because of various advantages such as reduced postoperative pain, faster recovery and more rapid return to normal activities, shorter hospital stay, and reduced postoperative pulmonary complications. The operative technique requires inflating gas into the abdominal cavity to provide a surgical procedure. An intra-abdominal pressure (IAP) of 10-15 mmHg is used.
Assessment of intravascular volume of patients is a challenging and important task in clinical practice maintaining hemodynamic stability is essential for reducing the rate of postoperative complications and intraoperative hypotension incidence (MAP < 60 mmHg). Although intraoperative hypotension has no universal definition, it has a serious impact on myocardial injury, acute kidney injury, septic complications, the risk of 30-day mortality, as well as the risk of one-year mortality in selected patient populations.
The IVC is a major, compliant vessel which carries up to 80% of venous blood returning to the right atrium, it is a large retroperitoneal vessel formed by the confluence of the right and left common iliac veins. Anatomically this usually occurs at the L5 vertebral level. The IVC lies along the right anterolateral aspect of the vertebral column and passes through the central tendon of the diaphragm around the T8 vertebral level.
Ultrasound measurement of the IVC has been studied extensively as a predictor of fluid responsiveness in a variety of patients under different circumstances, and several studies have demonstrated that IVC diameter and its variation are reliable indicators of intravascular volume status
During spontaneous respiration, the IVC collapses when intra-thoracic pressure decreases during inspiration and distends when intra-thoracic pressure increases during expiration.
The IVC CI, or caval index, can be calculated from [maximum (expiratory) – minimum (inspiratory) diameter]/maximum diameter percent, it represents the variation of IVC during spontaneous respiration.
This study was a prospective observational study conducted on 50 patients inside the operative theatre of El demerdash hospital after ethical committee approval with inclusion and exclusion criteria as following:
-Inclusion Criteria:
1. ASA (American Society of Anesthesiologists physical status classification) I-II
2. Aged between 18 and 60 years old who were scheduled for elective laparoscopic Cholecystectomy under general anesthesia.
-Exclusion Criteria:
1. ASA physical status > 2
2. Dyspnea
3. Systolic blood pressure ≥ 180 mmHg
4. Systolic blood pressure < 90 mmHg
5. Decompensated heart failure
6. Elevated pulmonary arterial pressure > 40mmHg
7. Significant valvular disease
8. Significant carotid stenosis
9. Documented negative fluid balance > 1.000 ml on preceding day
10. Agitation (RASS > 1)
11. IVC non visualized
12. Epidural catheter in use
We assessed preoperative IVC-CI using S880 Prime Portable Ultrasound Scanner Curvilinear 3 cm from interance of IVC into right atrium then we documented intraoperative measurements of MAP every 3 minutes starting from induction until the end of operation after that correlation between all these measurements indicated that There was a statistically significant negative correlation between IVC CI and Change of MBP (mmHg) After induction from baseline with; while Change of MBP (mmHg) After insufflation of abdomen from baseline was of negative correlation but insignificant as there was no dehydrated patients among this study group preoperatively according to our measurements and for ethical purposes we considered that if there was any patient needed hydration preoperative according to preoperative assessment of IVC-CI should be managed before surgery in order not to have intraoperative hypotension which can affect his wellness intra and postoperative, also all the patients were ASA I/II with no critical illness affect volemic status and usage of deprevan, fentanyl and atracurium during induction which can cause hypotension post induction.