Can the inferior vena cava collapsibility index be useful in predicting hypotension during spinal anaesthesia in a spontaneously breathing patient? A mini fluid challenge

Abstract

The study was performed at the Department of Orthopaedics and Traumatology of the Kauno Klinikos Hospital of Lithuanian University of Health Sciences. Background. Intravascular fluids are empirically administered to prevent hypotension induced by spinal anaesthesia. Ultrasound measurements of the inferior vena cava (IVC) and the IVC collapsibility index (IVC-CI) is a non-invasive method to evaluate the intravascular volume status. The aim of the study was to identify the prognostic value of the IVC collapsibility index in spontaneously breathing patients to predict severe intraoperative hypotension. Materials and methods. Sixty patients undergoing elective knee arthroplasty under spinal anaesthesia were included in the prospective study. The diameters of IVCex, IVCin, and IVC-CI were measured before and 15 min after spinal anaesthesia when administration of 500 ml of normal saline using infusion pump was finished. The haemodynamic parameters (heart rate, systolic, diastolic, and mean blood pressures, breathing rate) were collected. Results. Severe arterial hypotension was noticed in 18.3% of the patients. No statistically significant differences were detected between changes in IVCex, IVCin, and IVC-CI comparing hypotensive and non-hypotensive patients at the baseline and after the interventions (p > 0.005). According to receiver operating characteristic (ROC) analysis, IVC-CI is not effective in the prediction of severe hypotension during spinal anaesthesia in spontaneously breathing patients: the area under the ROC curve for IVC-CI was 0.05. Conclusions. IVC-CI is not an effective predictor of severe hypotension after induction of spinal anaesthesia followed by normal saline administration in spontaneously breathing patients undergoing elective knee arthroplasty. More trials, including different patient subgroups, will be needed.

Ultrasonography For Fluid Assessment in Parturients with Preeclampsia Undergoing Elective Cesarean Section Under Spinal Anesthesia

“…A previous study demonstrated similar finding regarding the IVC-CI for fluid assessment in spontaneously breathing patients. They found no significant differences in the max and min IVC diameters, and the IVC-CI between the hypotensive and non-hypotensive patients after induction of spinal anesthesia followed by normal saline administration (21) .…”

Assessment of role of inferior vena cava collapsibility index and variations in carotid artery peak systolic velocity in prediction of post-spinal anaesthesia hypotension in spontaneously breathing patients: An observational study

“…[ 15 ] Similar results were obtained by Jaremko et al . [ 16 ] who found no significant difference between baseline and post-intervention IVC parameters among the patients who were hypotensive after SA and those who were not.…”

The use of preoperative inferior vena cava ultrasound to predict anaesthesia-induced hypotension: a systematic review

“…The role of IVCUS to predict PSH was assessed in 15 studies [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25]. Among them 4 prospective observational studies evaluated PSH in a parturient undergoing caesarean section [11][12][13][14].…”

“…In studies among non-parturients, 4 studies were randomized controlled trials [15][16][17]25] and the rest were observational studies [18][19][20][21][22][23][24]. These studies were conducted in procedures such as hernia and hydrocele [16], orthopaedic lower limb surgery [15,[20][21][22], and various other operations performed under spinal anaesthesia. These studies included adult patients between 18 and 75 years old [19].…”