Observation of Principal Hemodynamic Variables After Spinal Anesthesia With Non Invasive Hemodynamic Monitoring

Prospective Observational Study About Variation of Principal Hemodynamic Parameters, Collected With Non-invasive Monitoring, in Patients Undergoing Spinal Anesthesia for Primary Elective Hip Arthroplasty.

The study is aimed at observe how spinal anesthesia modifies the hemodynamic state of the patient after optimization to preload independence with a Goal Directed Therapy algorithm guided by non invasive hemodynamic monitoring with Clearsight.

Study Overview

• Status: Completed
• Conditions: Fluid Therapy; Hemodynamics; Anesthesia, Spinal; Monitoring, Intraoperative

Detailed Description

This is an observational prospective single group study.

Patients will be monitored with ECG (III leads), non invasive blood pressure cuff (NIBP) cuff, pulse oximetry and Clearsight finger cuff after their arrival in the operating room. Basal Stroke Volume (SV) and indexed Stroke Volume (SVI) will be registered.

The basal value will be optimized according to the study goal directed fluid therapy algorithm: a 200ml fluid challenge will be administered until the SV will increase of at least 10%. When the SV will stop increasing significantly after crystalloid administration, the SV and SVI value will be registered as SVoptimized (SVopt) and SVI optimized (SVIopt), while the same values trigger of the last fluid challenge will be registered as SVtarget1 and SVItarget1. A constant infusion of crystalloids 2 ml/Kg/h will be maintained throughout the study period.

Then, spinal anesthesia will be administered (levobupivacaine 0.5% 0.25mg/kg of ideal weight) in lateral decubitus. After 15 minutes, patients will be turned supine and after 5 minutes SV and SVI will be registered and compared with values SVtarget1 and SVItarget1: if within 10% of range, data will be registered as SVtarget2 and SVItarget2 and patient will maintain basal crystalloid infusion. Otherwise, patients will receive a fluid optimization similar to what described previously before spinal, until values will be within 10% of range of SV and SVI.

Afterwards patients will be transferred to the operating room and will be followed as described in Figure 2. At the end of surgery, patients will be transferred to the Recovery Room and will be monitored and optimized.

When patients will reach an Aldrete's Score ≥ 9/10 and a Bromage's score = 0 with sensibility restored at S1, we will compare SV and SVI value with SVtarget1 and SVItarget1 and treated accordingly.

Spontaneous micturition will be tested and in case a bladder volume > 600ml will be detected with ultrasound before recovery room discharge criteria fulfillment, we will proceed with urinary catheterization.

At patient discharge from the Recovery Room the study will be completed.

• Study Type: Observational
• Enrollment (Actual): 30

Contacts and Locations

Study Locations

• Italy
  • Bologna, Italy, 40136
    • Istituto Ortopedico Rizzoli

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 50 years to 80 years (ADULT, OLDER_ADULT)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

• Sampling Method: Probability Sample

Study Population

Thirty patients aged between 50 and 80 years, with an American Society of Anaesthesiologists' (ASA) score 2 or 3 and scheduled for elective primary total hip arthroplasty under spinal anaesthesia. Exclusion criteria were contraindications to neuraxial anaesthesia, peripheral vascular abnormalities (severe vascular diseases, Raynaud's disease, arteriovenous fistula for hemodialysis, previous vascular surgery of the upper arms, advanced diabetes with neuropathy or vascular disease), ASA classes 1, 4 and 5 and patients' refusal.

Description

Inclusion Criteria:

• scheduled for elective primary hip arthroplasty
• scheduled for spinal anesthesia
• American Society of Anaesthesiologists' (ASA) score 2 or 3
• aged between 50 and 80 years

Exclusion Criteria:

• contraindications to neuraxial anaesthesia
• peripheral vascular abnormalities
• American Society of Anaesthesiologists' (ASA) score 1, 4 and 5
• patients' refusal

Study Plan

How is the study designed?

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
stroke volume and stroke volume index	stroke volume and stroke volume index variation after spinal anesthesia	duration of spinal anesthesia procedure

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
cardiac output and cardiac index	cardiac output and cardiac index variation after spinal anesthesia	duration of spinal anesthesia procedure
peripheral vascular resistance index (SVRI)	peripheral vascular resistance index variation after spinal anesthesia	duration of spinal anesthesia procedure
episodes of hypotension and hypertension intraoperatively	variation of Mean Arterial Pressure (MAP) +/- 30% os basal value	duration of surgery

Collaborators and Investigators

• Sponsor: Istituto Ortopedico Rizzoli

Study record dates

Study Major Dates

• Study Start: March 1, 2016
• Primary Completion (ACTUAL): May 1, 2016
• Study Completion (ACTUAL): May 1, 2016

Study Registration Dates

• First Submitted: February 28, 2017
• First Submitted That Met QC Criteria: March 15, 2017
• First Posted (ACTUAL): March 22, 2017

Study Record Updates

• Last Update Posted (ACTUAL): March 22, 2017
• Last Update Submitted That Met QC Criteria: March 15, 2017
• Last Verified: March 1, 2017

More Information

Terms related to this study

• Other Study ID Numbers: EmoSpin

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO