Use of ultrasonography for avoiding hypotension due to spinal anesthesia
- Conditions
- Other specified joint disorders,
- Registration Number
- CTRI/2020/10/028612
- Lead Sponsor
- S N Medical College and HSK Hospital
- Brief Summary
Spinal anaesthesia isfrequently used in daily clinical practice. Post spinal anaesthesia hypotension (PSAH) is a common side effectwith an incidence of 15.3% to 33% that may result in organ hypoperfusion andischaemic events1,2.The two fundamental factors in the pathogenesisof PSAH are sensory block level at or above T5 and age more than 40 years3.Patients’susceptibility to intra-operative hypotension can also be influenced by thepre-operative volume status that may differ according to comorbidities,physical status, pre-operative medications and fasting4.
PSAHdue to spinal blockade is principally a consequence of diminished systemicvascular resistance after blockade of preganglionic sympathetic fibers. Manyattempts have been tried to prevent PSAH, such as intravenous volume preload or prophylactic vasopressors. However,fluid co-load has been proved to lower the incidence of PSAH and significantlydecrease the vasopressor requirements. At the same time, empirical volumeloading carries the potential of volume overload, particularly in patients withcardiac disease. Consequently, the search for predictors of PSAH isbecoming mandatory to avoid blind volume loading and reserve it only forpatients who are expected to develop PSAH.
Severalmethodologies have been tried with a specific goal to predict PSAH, includingheart rate variability (HRV), passive leg raise test and perfusion index5,6,7.Althoughsome studies found a positive predictive value of HRV with high sensitivity andspecificity for PSAH, others concluded that it was not a reliable predictor asit can be influenced by numerous factors such as diabetes mellitus, ischaemicheart disease, antihypertensive medications, anxiety and spontaneousrespiration5.
Variousparameters have been investigated recently to estimate the pre-operativeintravascular volume status. Sonographic determination of inferior vena cavacollapsibility index (IVCCI) and IVC to aorta diameter index (IVC : Ao index) hasbeen introduced into clinical practice for the assessment of intravascularvolume in many studies and reported to be easy reliable and noninvasive for evaluating the volume status. So, the aimof this study is to evaluate the efficacy of both pre-operative IVCCI and IVC :Ao index for predicting the occurrence of PSAH.
- Detailed Description
Not available
Recruitment & Eligibility
- Status
- Closed to Recruitment of Participants
- Sex
- All
- Target Recruitment
- 120
- ASA physical status I to II.
- Age between 18 to 60 years.
- Patientss undergoing elective surgeries under spinal anaesthesia.
- Absolute or relative contraindications to spinal anaesthesia 2.
- Patients on angiotensin converting enzyme inhibitors, 3.
- Pregnant women 4.
- Emergency cases 5.
- BMI more than 30 kg m−2 6.
- Failure to perform spinal anaesthesia.
- Patients with a baseline arterial SBP less than 90 mmHg or mean arterial blood pressure (MBP) less than 70 mmHg.
Study & Design
- Study Type
- Observational
- Study Design
- Not specified
- Primary Outcome Measures
Name Time Method Based on our study, patients prone for spinal hypotension can be identified before anesthesia and can be treated effectively with crystalloids without causing fluid overload and thereby prevent spinal anesthesia induced hypotension and also reduce the requirement of vasoactive agents. Before starting surgery, at the end of the surgery
- Secondary Outcome Measures
Name Time Method •Perioperative fluid requirement •Requirement of vasopressors
Trial Locations
- Locations (1)
HSK HOSPITAL ,S N Medical College
🇮🇳Bagalkot, KARNATAKA, India
HSK HOSPITAL ,S N Medical College🇮🇳Bagalkot, KARNATAKA, IndiaDr Manjunath BPrincipal investigator09480013943manjunath0993@gmail.com