Femoral Vein Diameter to Predict Intraoperative Hypotension in Geriatric Patients Undergoing Orthopedic Surgery Under Spinal Anesthesia

Cairo University43 enrolled

Overview

The study aims to assess whether the transverse diameter of the right common femoral vein (RCFV) in the inguinal region could reflect the degree of post-spinal hypotension during elective orthopedic surgery.

Spinal anesthesia is commonly used in orthopedic procedures but often results in hypotension, particularly in elderly patients due to reduced cardiovascular reserve and impaired autonomic function. Ultrasound measurement of the right common femoral vein (RCFV) diameter has recently been proposed as a simple, non-invasive marker of intravascular volume status and a potential predictor of spinal anesthesia induced hypotension. To date, most evidence comes from obstetric populations undergoing cesarean delivery, limiting its applicability in other high-risk groups.

Study Type

OBSERVATIONAL

Enrollment

Conditions

Femoral Vein Diameter Intraoperative Hypotension Orthopedic Surgery Spinal Anesthesia

Interventions

Measurement of Femoral Vein DiameterOTHER

The transverse diameter of the right common femoral vein (RCFV) will be recorded 1 cm proximal to the junction with the great saphenous vein, at end-expiration.

Eligibility

Sex: ALLMin age: 60 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Age \> 60 years. * American Society of Anesthesiologists (ASA) physical state I-II. * Body mass index (BMI) ≤35 kg/m². Patients above this value will be excluded because obesity may cause technical difficulty and poor image quality in femoral vein ultrasound assessment. * Elective lower-limb orthopedic surgery under spinal anesthesia. Exclusion Criteria: * Patients refusing to participate. * History of psychiatric illness or seizures. * Absolute contraindications to spinal anesthesia: infection at the puncture site, severe coagulopathy/anticoagulation \[defined as platelet count \<75,000/µL, International Normalized Ratio (INR) \>1.5, Activated Partial Thromboplastin Time (aPTT) \>1.5 times control, or the use of anticoagulants such as warfarin, heparin, low molecular weight heparin, or direct oral anticoagulants within the recommended safety interval for neuraxial anesthesia\], severe hypovolemia, increased intracranial pressure, or known allergy to local anesthetics. * Severe cardiac disease, including left ventricular ejection fraction \<30%, Severe valvular heart disease (e.g., critical aortic stenosis), clinically significant arrhythmias (atrial fibrillation with uncontrolled ventricular rate \>120 bpm, frequent ventricular ectopy or sustained ventricular tachyarrhythmia) and congestive heart failure such as New York Heart Association (NYHA) class III-IV. * Severe uncontrolled hypertension, defined as persistent mean arterial pressure (MAP) ≥120 mmHg or systolic blood pressure (SBP) ≥180 mmHg and/or diastolic blood pressure (DBP) ≥110 mmHg despite medical therapy. * Severe respiratory diseases (Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage III-IV chronic obstructive pulmonary disease, or forced vital capacity (FVC) \<50% predicted). * Baseline bradycardia (\<50) or mean arterial blood pressure less than 60mmHg. * Emergency surgeries.

Locations (1)

Cairo University

Cairo, Egypt

RECRUITING

Outcomes

Primary Outcomes

Predictive ability of the transverse diameter of the right common femoral vein (RCFV)

The predictive ability of the transverse diameter of the right common femoral vein (RCFV), measured by ultrasound before spinal anesthesia, for the development of post-spinal hypotension in geriatric patients undergoing orthopedic surgery.

Time frame: At end-expiration (Up to 15 minutes)

Secondary Outcomes

Severity of post spinal hypotension

Severity of post spinal hypotension \[defined as a decrease in the mean arterial pressure (MAP) \>20% from baseline\]. Severity of hypotension, classified as: * Mild: 20-30% decrease in MAP from baseline. * Moderate: 30-40% decrease in MAP from baseline. * Severe: \>40% decrease in MAP from baseline or absolute MAP \<60 mmHg.

Time frame: 24 hours postoperatively

Incidence of adverse events

Incidence of adverse events such as hypotension and/or bradycardia will be recorded.

Time frame: 24 hours postoperatively

Requirement of rescue medications

Requirement of rescue medications will be recorded.

Time frame: 24 hours postoperatively

Central Contacts

Hebatullah S Abdelhamid, MD

CONTACT

00201044512277 drhebasalah593@gmail.com

Data from ClinicalTrials.gov

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