Spinal-Induced Hypotension in Geriatric Patients

Tanta University120 enrolled

Overview

The study will be conducted to asses preoperative condition of venous system by VExUS score and it's relation with the incidence of spinal induced hypotension in geriatric patients undergoing surgery with spinal anaesthesia.

An assessment of the intravascular volume deficit prior to the spinal anaesthesia conduction may help to predict the occurrence of a critical decrease in blood pressure, so several indices have been proposed to assess it's status depending on either a fluid challenge or an assessment of heart-lung interaction. Heart rate variability, passive leg raise test, and peripheral perfusion index have revealed good abilities to predict spinal induced hypotension. The inferior vena cava (IVC) collapsibility index provides high diagnostic accuracy in predicting spinal induced hypotension The VeXUS score is a four-staged validated protocol which evaluates the presence and severity of systemic venous congestion in the inferior vena cava (IVC) and organs (liver, gut, and kidneys) by evaluating the (IVC) diameter, venous waveforms of the hepatic vein (HV), portal vein (PV), and interlobar renal veins using colour Doppler (CD) and pulsed wave Doppler (PWD)

Study Type

OBSERVATIONAL

Enrollment

120

Conditions

Spinal Induced Hypotension Geriatric Population Intravascular Volume

Interventions

venous excess ultrasound scoreDIAGNOSTIC_TEST

Venous congestion is classified into 4 grades. If the Inferior vena cava is not plethoric, there is deemed to be no congestion (grade 0), and further Doppler examination is not performed. When the IVC is plethoric but there are no severely abnormal waveforms (defined as S-wave reversal on hepatic, \>50% pulsatility on portal, and a monophasic pattern on intrarenal Doppler), congestion is considered to be mild (grade 1). Plethoric IVC with at least 1 severely abnormal pattern is considered to be moderate congestion (grade 2), while 2 or more abnormal Doppler patterns constitute severe congestion (grade 3)

Eligibility

Sex: ALLMin age: 65 Years

Medical Language ↔ Plain English

Inclusion Criteria: * . Patients aging 65 or older * Lower body surgeries to be done with spinal anaesthesia * BMI less than 30 kg/m2. * Patients with ASA I-III Exclusion Criteria: * Patient refusal * Major bloody surgeries (class c surgeries) * Patients with a history of cardiovascular disorders including arrhythmias, heart failure, tricuspid or mitral regurgitation, dilated right atrium or ventricle, AF * Patients with a history of respiratory disorders * Patients with cirrhotic liver * Patients with pulmonary hypertension * Patients with renal diseases

Locations (1)

tarek Abdelhay Mostafa

Tanta, El Gharbyia, Egypt

Outcomes

Primary Outcomes

venous excess ultrasound score

score used to assess venous circulation

Time frame: immediate preoperative period before the induction of spinal anesthesia

Data from ClinicalTrials.gov

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