Fluid administration guided by inferior vena cava ultrasound before spinal anaesthesia may reduce post procedural hypotension rate

Abstract

PURPOSE: This study was conducted to estimate the incidence of hypotension after spinal anesthesia after inferior vena cava ultrasound (IVCUS) guided volaemic optimization compared with a control group in patients undergoing elective surgery. According to ESICM guidelines, hypotension was defined as two systolic arterial pressure (SAP) measurements < 80 mmHg and / or a mean arterial pressure (MAP) < 60 mmHg, or a drop in SAP of more than 50 mmHg or more than 25% from baseline, or a decrease in MAP by more than 30% from baseline and / or clinical signs/symptoms of inadequate perfusion. MATERIALS AND METHODS: From May 2014 to February 2019, a prospective, controlled, randomised, three-arm, parallel-group trial was performed in our tertiary hospital. In the IVCUS group (I, 132 patients) and passive leg raising test group (L, 148 patients), a pre-anaesthesia volume optimization was achieved following a fluid response protocol. In control group (C, 149 patients), no specific intervention was performed. RESULTS: 474 patients were collected. In group I, hypotension rate was 35%. In group L hypotension rate was 44%. In group C hypotension rate was 46%. An 11% reduction rate in hypotension (95% CI -1 to -24%, P=0.047) was observed between the group I and the group C. A 2% reduction rate in hypotension (95% CI -3 to -5%, P=0.428) was observed between group L and the group C. Total fluid amount administered was greater in the I group I than in the group C (593 ml versus 453 ml, P=0.015) and greater in the group L than the group C (511 ml versus 453 ml, P=0.11). CONCLUSION: IVCUS guided fluid optimization decrease the incidence of arterial hypotension after spinal anesthesia.