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Pre-operative ultrasonographic evaluation of inferior vena cava collapsibility index and caval aorta index as new predictors for hypotension after induction of spinal anaesthesia: A prospective observational study.
Eur J Anaesthesiol. 2019 04; 36(4):297-302.EJ

Abstract

BACKGROUND

Hypotension after spinal anaesthesia is a common side effect that may be harmful. Patients' susceptibility to intra-operative hypotension can be affected by many pre-operative factors.

OBJECTIVES

The current study aimed to evaluate the efficacy of both pre-operative inferior vena cava collapsibility index (IVCCI) and inferior vena cava to aorta diameter (IVC : Ao) index for predicting postspinal anaesthesia hypotension (PSAH).

DESIGN

Prospective observational blinded study.

SETTING

Operating room from June 2017 to February 2018.

PATIENTS

One hundred adult patients of both sexes, American Society of Anesthesiologists' physical status 1 or 2 scheduled for elective surgery under spinal anaesthesia were included in this study.

INTERVENTIONS

Patients received spinal anaesthesia performed at the level of L3 to 4 or L4 to 5 intervertebral space with the patient in the sitting position then placed in the supine position immediately after neuraxial block and kept supine throughout the study period (30 min). IVCCI and IVC : Ao index were assessed pre-operatively. Baseline noninvasive blood pressure was recorded before administration of spinal anaesthesia then every minute after spinal blockade for 30 min.

MAIN OUTCOME MEASURES

The primary outcome was to evaluate the predictive values of both IVCCI and IVC : Ao index for detecting PSAH and the secondary outcomes were to compare the predictive values of both IVCCI and IVC : Ao index and to detect other clinical predictors for PSAH using logistic regression analysis.

RESULTS

Forty-five patients developed PSAH (45%). IVCCI was significantly higher in patients who developed PSAH than in patients who did not, while IVC : Ao index was significantly lower in patients who developed PSAH than in patients who did not. Hypotension after induction of spinal anaesthesia was defined as an absolute value of SBP less than 90 mmHg, a decrease in SBP more than 30% of the baseline value or an absolute value of arterial blood pressure less than 60 mmHg. Logistic regression analysis revealed that IVCCI and IVC : Ao index were good predictors of the occurrence of PSAH. Receiver operating characteristic curve analysis showed that IVC : Ao index had a sensitivity of 96%, a specificity of 88%, and an accuracy of 95% to predict PSAH at a cut-off point less than 1.2. IVCCI had a sensitivity of 84%, a specificity of 77%, and an accuracy of 84% to predict PSAH at a cut-off point more than 44.7%.

CONCLUSION

Pre-operative IVCCI and IVC : Ao index are good predictors of the occurrence of PSAH. However, IVC : Ao index is a more powerful predictor than IVCCI.

Authors+Show Affiliations

From the Department of Anaesthesia & Surgical ICU, Faculty of Medicine, Tanta University, Tanta, Egypt (ERS) and Magrabi Hospital, Jeddah, KSA (ME).No affiliation info available

Pub Type(s)

Journal Article
Observational Study

Language

eng

PubMed ID

30664523

Citation

Salama, Eman Ramadan, and Mohamed Elkashlan. "Pre-operative Ultrasonographic Evaluation of Inferior Vena Cava Collapsibility Index and Caval Aorta Index as New Predictors for Hypotension After Induction of Spinal Anaesthesia: a Prospective Observational Study." European Journal of Anaesthesiology, vol. 36, no. 4, 2019, pp. 297-302.
Salama ER, Elkashlan M. Pre-operative ultrasonographic evaluation of inferior vena cava collapsibility index and caval aorta index as new predictors for hypotension after induction of spinal anaesthesia: A prospective observational study. Eur J Anaesthesiol. 2019;36(4):297-302.
Salama, E. R., & Elkashlan, M. (2019). Pre-operative ultrasonographic evaluation of inferior vena cava collapsibility index and caval aorta index as new predictors for hypotension after induction of spinal anaesthesia: A prospective observational study. European Journal of Anaesthesiology, 36(4), 297-302. https://doi.org/10.1097/EJA.0000000000000956
Salama ER, Elkashlan M. Pre-operative Ultrasonographic Evaluation of Inferior Vena Cava Collapsibility Index and Caval Aorta Index as New Predictors for Hypotension After Induction of Spinal Anaesthesia: a Prospective Observational Study. Eur J Anaesthesiol. 2019;36(4):297-302. PubMed PMID: 30664523.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Pre-operative ultrasonographic evaluation of inferior vena cava collapsibility index and caval aorta index as new predictors for hypotension after induction of spinal anaesthesia: A prospective observational study. AU - Salama,Eman Ramadan, AU - Elkashlan,Mohamed, PY - 2019/1/22/pubmed PY - 2019/12/4/medline PY - 2019/1/22/entrez SP - 297 EP - 302 JF - European journal of anaesthesiology JO - Eur J Anaesthesiol VL - 36 IS - 4 N2 - BACKGROUND: Hypotension after spinal anaesthesia is a common side effect that may be harmful. Patients' susceptibility to intra-operative hypotension can be affected by many pre-operative factors. OBJECTIVES: The current study aimed to evaluate the efficacy of both pre-operative inferior vena cava collapsibility index (IVCCI) and inferior vena cava to aorta diameter (IVC : Ao) index for predicting postspinal anaesthesia hypotension (PSAH). DESIGN: Prospective observational blinded study. SETTING: Operating room from June 2017 to February 2018. PATIENTS: One hundred adult patients of both sexes, American Society of Anesthesiologists' physical status 1 or 2 scheduled for elective surgery under spinal anaesthesia were included in this study. INTERVENTIONS: Patients received spinal anaesthesia performed at the level of L3 to 4 or L4 to 5 intervertebral space with the patient in the sitting position then placed in the supine position immediately after neuraxial block and kept supine throughout the study period (30 min). IVCCI and IVC : Ao index were assessed pre-operatively. Baseline noninvasive blood pressure was recorded before administration of spinal anaesthesia then every minute after spinal blockade for 30 min. MAIN OUTCOME MEASURES: The primary outcome was to evaluate the predictive values of both IVCCI and IVC : Ao index for detecting PSAH and the secondary outcomes were to compare the predictive values of both IVCCI and IVC : Ao index and to detect other clinical predictors for PSAH using logistic regression analysis. RESULTS: Forty-five patients developed PSAH (45%). IVCCI was significantly higher in patients who developed PSAH than in patients who did not, while IVC : Ao index was significantly lower in patients who developed PSAH than in patients who did not. Hypotension after induction of spinal anaesthesia was defined as an absolute value of SBP less than 90 mmHg, a decrease in SBP more than 30% of the baseline value or an absolute value of arterial blood pressure less than 60 mmHg. Logistic regression analysis revealed that IVCCI and IVC : Ao index were good predictors of the occurrence of PSAH. Receiver operating characteristic curve analysis showed that IVC : Ao index had a sensitivity of 96%, a specificity of 88%, and an accuracy of 95% to predict PSAH at a cut-off point less than 1.2. IVCCI had a sensitivity of 84%, a specificity of 77%, and an accuracy of 84% to predict PSAH at a cut-off point more than 44.7%. CONCLUSION: Pre-operative IVCCI and IVC : Ao index are good predictors of the occurrence of PSAH. However, IVC : Ao index is a more powerful predictor than IVCCI. SN - 1365-2346 UR - https://www.unboundmedicine.com/medline/citation/30664523/Pre_operative_ultrasonographic_evaluation_of_inferior_vena_cava_collapsibility_index_and_caval_aorta_index_as_new_predictors_for_hypotension_after_induction_of_spinal_anaesthesia:_A_prospective_observational_study_ L2 - https://doi.org/10.1097/EJA.0000000000000956 DB - PRIME DP - Unbound Medicine ER -