Spinal anesthesia induces sympathetic blockade and venodilation, thus reducing venous return and the cardiac output. Therefore, assessment of intravascular volume deficit before anesthesia might predict a critical decrease in blood pressure after anesthesia. Recently, ultrasonographic evaluation of the internal jugular vein (IJV) has been used to reflect intravascular volume status and fluid and as a predictor of hypotension after induction of general anesthesia. Carotid intima-media thickness (CIMT) has been used to predict atherosclerosis-related events, such as stroke, myocardial infarction, peripheral artery disease, and hypotension after induction of anesthesia with a cut-off value of 0.65 mm of CIMT as a threshold level.
This study aims to evaluate the ability of preoperative Ultrasonographic assessment of the internal jugular vein (IJV) and Carotid intima-media thickness (CIMT) to predict spinal anesthesia induced hypotension (SAIH). Participants will be elderly patients (above 60 years), ASA I-II-III, scheduled for elective surgeries under spinal anesthesia.
Study Type
OBSERVATIONAL
Enrollment
71
Patient will be in supine position, The linear probe with frequency of 7- 12 M hz; depth of 3 cm. maximum IJV diameter (IJV-D) and area (IJV-A) will be recorded. M-mode will be used to obtain the distance between the 2 walls of the vein during inspiration and expiration. Then, the patient will be positioned 10° Trendelenburg and similar ultrasonographic measurements will be again performed
US Probe is slided superiorly (toward the head) or inferiorly (toward the feet) until the bifurcation of the common carotid artery (CCA) appears on the left side of the screen. This is the ideal location for imaging and CIMT measurements. IMT is assessed in longitudinal view from the arterial far wall, along a 10mm length. CIMT will appear as two parallel lines (leading edges of two anatomical boundaries) from it: lumen- intima and media- adventitia interfaces perpendicular to ultrasound beams.
Spinal anesthesia will be performed in the sitting position at level of L3-4 or L4- 5 interspaces with a 25-gauge spinal needle. Local infiltration of skin and subcutaneous tissue with 2% lignocaine will be applied. After confirming cerebrospinal fluid flow, 10 mg of 0.5% hyperbaric bupivacaine plus 25 mcg fentanyl will be injected. The degree of sensory block (cold test by alcohol gauze) will be assessed in the study with a goal of T8 dermatomal level block.
Kasr Alainy hospital
Cairo, Egypt
Accuracy of IJV collapsibility index as predictor of Spinal anesthesia induced hypotension.
(Area under receiver operating characteristic curves)
Time frame: 10 minutes
Accuracy of rate of change in IJV area with change in posture as a predictor of Spinal anesthesia induced hypotension.
(Area under receiver operating characteristic curves)
Time frame: 10 minutes
Incidence of Spinal anesthesia induced hypotension
Change in mean arterial blood pressure 25% less than the preoperative baseline level.
Time frame: 20 minutes
Carotid intima media thickness.
IMT is measured as the distance between lumen-intima and media-adventitia interfaces
Time frame: 10 minutes
Norepinephrine consumption
the total dose of norepiniphrine and number of boluses
Time frame: 20 minutes
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