The Utility of Echocardiography for the Prediction of Spinal-Induced Hypotension in Elderly Patients: Inferior Vena Cava Assessment Is a Key Player

Saranteas, Theodosios; Spiliotaki, Helen; Koliantzaki, Iosifina; Koutsomanolis, Dimosthenis; Kopanaki, Evangelia; Papadimos, Thomas J; Kostopanagiotou, Georgia

doi:10.1053/j.jvca.2019.02.032

Cited by 24 publications

(49 citation statements)

References 27 publications

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“…In a recent study, Salama et al reported that IVC-CI was significantly higher in patients who developed postspinal anesthesia hypotension than in patients who did not [21]. Also, in the study conducted by Saranteas et al, it was found that preoperative dIVC max/ IVC-CI predicted spinal-induced hypotension better than echocardiographic measurements [22]. SAP =systolic blood pressure; DAP = diastolic blood pressure; MAP = mean blood pressure; HR = heart rate; SpO 2 = peripheral oxygen pressure; MAS (min) = time (in minutes) for patients to reach a Modified Aldrete Score of 10 after the procedure.…”

Section: Discussionmentioning

confidence: 95%

“…In a recent study, Salama et al reported that IVC-CI was significantly higher in patients who developed postspinal anesthesia hypotension than in patients who did not [21]. Also, in the study conducted by Saranteas et al, it was found that preoperative dIVC max/ IVC-CI predicted spinal-induced hypotension better than echocardiographic measurements [22]. Noninvasive transthoracic echocardiography (TTE) examination is possible using portable ultrasound systems [23][24][25][26][27].…”

Section: Discussionmentioning

confidence: 99%

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The role of right ventricular volumes and inferior vena cava diameters in the evaluation of volume status before colonoscopy

2019

Turk J Med Sci

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Background/aim: Ultrasonographic measurements of inferior vena cava (IVC) diameters and right ventricle (RV) volumes are important tools for the evaluation of intravascular volume. The current study investigates the association of IVC diameters and RV volumes before colonoscopy in prediction of postanesthesia hypotension. Materials and methods: Seventy patients scheduled for colonoscopy were included in the study. Preoperatively, expirium (dIVC max) and inspirium (dIVC min) IVC diameters were measured using M-mode ultrasonography and the collapsibility index (IVC-CI) was calculated. Ventricular volumes and areas were also measured using transthoracic echocardiography. Postanesthesia hypotension was defined as mean arterial blood pressure of <60 mmHg or a decrease of >30% in the mean arterial pressure after sedation. Results: Minimum and maximum IVC diameters were significantly lower (P = 0.005 and P < 0.001, respectively) and IVC-CI was significantly higher (P < 0.001) in patients who developed hypotension. Similarly, right ventricular end-diastolic area (RV-EDA), right ventricular end-systolic area (RV-ESA), right ventricular end-diastolic volume (RV-EDV), right ventricular end-systolic volume (RV-ESV), and left ventricular end-systolic volume (LV-ESV) values were significantly lower in patients with hypotension (P < 0.05). Logistic regression analysis showed that dIVC min and RV-ESA were independent predictors of hypotension. Conclusion: IVC diameters and RV-ESA, RV-EDA, RV-ESV, and RV-EDV are good indicators of preoperative volume status and can be used to predict the patients at risk of developing hypotension.

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Section: Discussionmentioning

confidence: 95%

“…In a recent study, Salama et al reported that IVC-CI was significantly higher in patients who developed postspinal anesthesia hypotension than in patients who did not [21]. Also, in the study conducted by Saranteas et al, it was found that preoperative dIVC max/ IVC-CI predicted spinal-induced hypotension better than echocardiographic measurements [22]. Noninvasive transthoracic echocardiography (TTE) examination is possible using portable ultrasound systems [23][24][25][26][27].…”

Section: Discussionmentioning

confidence: 99%

The role of right ventricular volumes and inferior vena cava diameters in the evaluation of volume status before colonoscopy

2019

Turk J Med Sci

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“…In our study, patients receiving the combined spinal-epidural anesthesia also had significantly greater hemodynamic variations compared to those receiving general anesthesia with LMA and nerve block. Spinal anesthesia can inhibit the sympathetic nerves, leading to peripheral vascular dilation and hypotension [8][9][10]. In addition, vagus nerve dominance and slow heart rate during spinal anesthesia may also result in significant hemodynamic variations.…”

Section: Discussionmentioning

confidence: 99%

Comparison of general anesthesia with endotracheal intubation, combined spinal-epidural anesthesia, and general anesthesia with laryngeal mask airway and nerve block for intertrochanteric fracture surgeries in elderly patients: a retrospective cohort study

Liu¹,

Su²,

Li³

et al. 2019

BMC Anesthesiol

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Background: There is no consensus on the optimal anesthesia method for intertrochanteric fracture surgeries in elderly patients. Our study aimed to compare the hemodynamics and perioperative outcomes of general anesthesia with endotracheal intubation, combined spinal-epidural anesthesia, and general anesthesia with laryngeal mask airway (LMA) and nerve block for intertrochanteric fracture surgeries in elderly patients. Methods: This is a retrospective study of 75 patients aged > 60 years scheduled for intertrochanteric fracture surgeries with general anesthesia with intubation (n = 25), combined spinal-epidural anesthesia (n = 25), and general anesthesia with LMA and nerve block (n = 25). The intraoperative hemodynamics were recorded, and the maximum variation rate was calculated. Postoperative analgesic effect was evaluated using the visual analog scale (VAS). Postoperative cognitive status was assessed using the Mini-Mental State Exam (MMSE). Results: The maximum variation rate of intraoperative heart rate, systolic blood pressure, diastolic blood pressure differed significantly between the three groups (general anesthesia with intubation > combined spinal-epidural anesthesia > general anesthesia with LMA and nerve block). The VAS scores postoperative 2 h, 4 h, 6 h, and 8 h also differed significantly between the three groups (general anesthesia with intubation > combined spinal-epidural anesthesia > general anesthesia with LMA and nerve block). The VAS scores postoperative 24 h were significantly lower in the general anesthesia with LMA/nerve block group than the general anesthesia with intubation group and the combined spinal-epidural anesthesia group. The MMSE scores postoperative 15 min and 45 min differed significantly between the three groups (general anesthesia with intubation < combined spinal-epidural anesthesia < general anesthesia with LMA and nerve block). The MMSE scores postoperative 120 min in the general anesthesia with intubation group were the lowest among the three groups. There was no significant difference in the incidence of respiratory infection postoperative 24 h, 48 h, and 72 h between the three groups.

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“…It is predicted that SA-related hypotension might develop in the case of hypovolemia. In the study conducted by Theodosius Saranteas et al, it was concluded that the dIVCmax-IVCCI ratio was the determinant of SA-related hypotension in elderly patients [10] . Unlike this study, in the study that was conducted by Mačiulienė A et al, it was determined that the decrease in IVC diameters and the increase in IVC-CI did not predict hypotension under SA in patients undergoing elective knee joint replacement surgery [11] .…”

Section: Specificitymentioning

confidence: 96%

Value of Transthoracic Echocardiography in the Prediction of Post-spinal Anesthesia Hypotension

Gülaştı¹,

Gülaştı²,

Girgin³

et al. 2020

GKDA Derg

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INTRODUCTION: Spinal Anesthesia (SA) can lead to hypotension due to sympathic denervation, which causes a reduction in venous return to the heart as a result of peripheral vasodilation and redistribution of intravascular blood. Transthoracic Echocardiography (TTE) is a noninvasive and easy-to-use method to visualize cardiac reserve and functions. We aimed to evaluate whether parameters attained via transthoracic echocardiography are predictive of development of post-SA hypotension. METHODS: Forty-two patients between the ages of 18 and 80, who would undergo inguinal hernia operation under SA, with ASA physical status I-II and had no clinically recognized cardiovascular disease, were included in the study. TTE was performed for each patient 30 minutes before the operation, and measurements were recorded along with the intraoperative hemodynamic parameters. RESULTS: There was a statistically significant difference between the medians of left ventricle end-diastolic diameter (LVEDD) (cm) according to the status of post-SA hypotension (p=0.003).Accordingly, median LVEDD of patients who did not develop hypotension was significantly larger compared with that of those who had hypotension. Similarly, a statistically significant difference emerged between the medians of right ventricular (RV) tricuspid annular plane systolic excursion (TAPSE) (cm) showing RV global function according to the status of post-SA hypotension (p=0.001). Accordingly, patients who did not have hypotension had a larger RV-TAPSE median compared with that of those who had hypotension. The difference between the medians of RV isovolumetric relaxation time (RV-IVRT), which is one of the indicators of RV diastolic functions was again statistically significant according to the status of post-SA hypotension (p=0.025). DISCUSSION AND CONCLUSION: TAPSE, RV-IVRT and LVEDD measured via preoperative TTE, can be significant parameters to predict the development of post-SA hypotension.

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The Utility of Echocardiography for the Prediction of Spinal-Induced Hypotension in Elderly Patients: Inferior Vena Cava Assessment Is a Key Player

Cited by 24 publications

References 27 publications

The role of right ventricular volumes and inferior vena cava diameters in the evaluation of volume status before colonoscopy

The role of right ventricular volumes and inferior vena cava diameters in the evaluation of volume status before colonoscopy

Comparison of general anesthesia with endotracheal intubation, combined spinal-epidural anesthesia, and general anesthesia with laryngeal mask airway and nerve block for intertrochanteric fracture surgeries in elderly patients: a retrospective cohort study

Value of Transthoracic Echocardiography in the Prediction of Post-spinal Anesthesia Hypotension

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