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Measurements of Inferior Vena Cava Diameter for Prediction of Hypotension and Bradycardia during Spinal Anesthesia in Spontaneously Breathing Patients during Elective Knee Joint Replacement Surgery.
Medicina (Kaunas). 2018 Jul 12; 54(3)M

Abstract

Background and objective: Hypotension and bradycardia are the most common hemodynamic disorders and side effects of spinal anesthesia (SA) on the cardiovascular system. SA-induced sympathetic denervation causes peripheral vasodilatation and redistribution of central blood volume that may lead to decreased venous return to the heart. The aim of the study was to evaluate the changes of inferior vena cava collapsibility index (IVC-CI) during SA in spontaneously breathing patients during elective knee joint replacement surgery to prognose manifestation of intraoperative hypotension and bradycardia. Materials and methods: 60 patients (American Society of Anesthesiologists (ASA) physical status I or II, no clinically significant cardiovascular pathology) of both sexes undergoing elective knee joint replacement surgery under SA were included in the prospective study. Inspiratory and expiratory inferior vena cava (IVCin, IVCex) diameters were measured using an ultrasound device in supine position before and immediately after SA, then 15 min, 30 min, and 45 min after SA was performed. The heart rate, along with systolic, diastolic, and mean arterial blood pressures were collected. The parameters were measured at the baseline and at the next four time points.

Results:

There were no significant changes in IVCin, IVCex, and IVC-CI compared to baseline and other time point measurements in hypotensive versus nonhypotensive and bradycardic versus nonbradycardic patients (p > 0.05). Changes in IVC diameter do not prognose hypotension and/or bradycardia during SA: the area under the curve (AUC) of the receiver operating characteristic (ROC) curve for IVC-CI at all measuring points was <0.7, p > 0.05.

Conclusions:

Reduction in IVC diameters and increase in IVC-CI do not predict hypotension and bradycardia during SA in spontaneously breathing patients undergoing elective knee joint replacement surgery.

Authors+Show Affiliations

Department of Anaesthesiology, Medical Academy, Lithuanian University of Health Sciences, Eivenių 2, LT-50009 Kaunas, Lithuania. asta.maciuliene@lsmuni.lt.Department of Anaesthesiology, Medical Academy, Lithuanian University of Health Sciences, Eivenių 2, LT-50009 Kaunas, Lithuania. arunas.gelmanas@lsmuni.lt.Department of Anaesthesiology, Medical Academy, Lithuanian University of Health Sciences, Eivenių 2, LT-50009 Kaunas, Lithuania. inna.jaremko@fc.lsmuni.lt.Department of Anaesthesiology, Medical Academy, Lithuanian University of Health Sciences, Eivenių 2, LT-50009 Kaunas, Lithuania. ramunas.tamosiunas@lsmuni.lt.Department of Orthopaedics and Traumatology, Medical Academy, Lithuanian University of Health Sciences, Eivenių 2, LT-50009 Kaunas, Lithuania. alfredas.smailys@lsmuni.lt.Department of Anaesthesiology, Medical Academy, Lithuanian University of Health Sciences, Eivenių 2, LT-50009 Kaunas, Lithuania. andrius.macas@lsmuni.lt.

Pub Type(s)

Evaluation Study
Journal Article

Language

eng

PubMed ID

30344280

Citation

Mačiulienė, Asta, et al. "Measurements of Inferior Vena Cava Diameter for Prediction of Hypotension and Bradycardia During Spinal Anesthesia in Spontaneously Breathing Patients During Elective Knee Joint Replacement Surgery." Medicina (Kaunas, Lithuania), vol. 54, no. 3, 2018.
Mačiulienė A, Gelmanas A, Jaremko I, et al. Measurements of Inferior Vena Cava Diameter for Prediction of Hypotension and Bradycardia during Spinal Anesthesia in Spontaneously Breathing Patients during Elective Knee Joint Replacement Surgery. Medicina (Kaunas). 2018;54(3).
Mačiulienė, A., Gelmanas, A., Jaremko, I., Tamošiūnas, R., Smailys, A., & Macas, A. (2018). Measurements of Inferior Vena Cava Diameter for Prediction of Hypotension and Bradycardia during Spinal Anesthesia in Spontaneously Breathing Patients during Elective Knee Joint Replacement Surgery. Medicina (Kaunas, Lithuania), 54(3). https://doi.org/10.3390/medicina54030049
Mačiulienė A, et al. Measurements of Inferior Vena Cava Diameter for Prediction of Hypotension and Bradycardia During Spinal Anesthesia in Spontaneously Breathing Patients During Elective Knee Joint Replacement Surgery. Medicina (Kaunas). 2018 Jul 12;54(3) PubMed PMID: 30344280.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Measurements of Inferior Vena Cava Diameter for Prediction of Hypotension and Bradycardia during Spinal Anesthesia in Spontaneously Breathing Patients during Elective Knee Joint Replacement Surgery. AU - Mačiulienė,Asta, AU - Gelmanas,Arūnas, AU - Jaremko,Inna, AU - Tamošiūnas,Ramūnas, AU - Smailys,Alfredas, AU - Macas,Andrius, Y1 - 2018/07/12/ PY - 2018/02/21/received PY - 2018/06/20/revised PY - 2018/07/09/accepted PY - 2018/10/23/entrez PY - 2018/10/23/pubmed PY - 2019/10/8/medline KW - bradycardia KW - hypotension KW - inferior vena cava KW - intravascular volume KW - spinal anesthesia JF - Medicina (Kaunas, Lithuania) JO - Medicina (Kaunas) VL - 54 IS - 3 N2 - Background and objective: Hypotension and bradycardia are the most common hemodynamic disorders and side effects of spinal anesthesia (SA) on the cardiovascular system. SA-induced sympathetic denervation causes peripheral vasodilatation and redistribution of central blood volume that may lead to decreased venous return to the heart. The aim of the study was to evaluate the changes of inferior vena cava collapsibility index (IVC-CI) during SA in spontaneously breathing patients during elective knee joint replacement surgery to prognose manifestation of intraoperative hypotension and bradycardia. Materials and methods: 60 patients (American Society of Anesthesiologists (ASA) physical status I or II, no clinically significant cardiovascular pathology) of both sexes undergoing elective knee joint replacement surgery under SA were included in the prospective study. Inspiratory and expiratory inferior vena cava (IVCin, IVCex) diameters were measured using an ultrasound device in supine position before and immediately after SA, then 15 min, 30 min, and 45 min after SA was performed. The heart rate, along with systolic, diastolic, and mean arterial blood pressures were collected. The parameters were measured at the baseline and at the next four time points. Results: There were no significant changes in IVCin, IVCex, and IVC-CI compared to baseline and other time point measurements in hypotensive versus nonhypotensive and bradycardic versus nonbradycardic patients (p > 0.05). Changes in IVC diameter do not prognose hypotension and/or bradycardia during SA: the area under the curve (AUC) of the receiver operating characteristic (ROC) curve for IVC-CI at all measuring points was <0.7, p > 0.05. Conclusions: Reduction in IVC diameters and increase in IVC-CI do not predict hypotension and bradycardia during SA in spontaneously breathing patients undergoing elective knee joint replacement surgery. SN - 1648-9144 UR - https://www.unboundmedicine.com/medline/citation/30344280/Measurements_of_Inferior_Vena_Cava_Diameter_for_Prediction_of_Hypotension_and_Bradycardia_during_Spinal_Anesthesia_in_Spontaneously_Breathing_Patients_during_Elective_Knee_Joint_Replacement_Surgery_ L2 - http://www.mdpi.com/resolver?pii=medicina54030049 DB - PRIME DP - Unbound Medicine ER -