Ultrasonographic Assessment of Neck Vessels as Predictors of Spinal Anesthesia Induced Hypotension in Elderly

Pre-anesthetic Ultrasonographic Assessment of Neck Vessels as Predictors of Spinal Anesthesia Induced Hypotension in Elderly: a Prospective Observational Study.

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.

Study Overview

• Status: Completed
• Conditions: Post-spinal Hypotension
• Intervention / Treatment: Device: IJV Ultrasonography; Device: Carotid Intima Media Thickness; Procedure: Spinal anesthesia

Detailed Description

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 (Actual): 71

Contacts and Locations

Study Locations

• Egypt
  • Cairo, Egypt
    • Kasr Alainy Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 60 years to 90 years (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

• Sampling Method: Probability Sample

Study Population

Participants will be elderly patients (above 60 years), ASA I-II-III, scheduled for elective surgeries under spinal anesthesia.

Description

Inclusion Criteria:

• Adult patients (>60 years)
• ASA I-II-III
• Patients scheduled for elective surgeries under spinal anesthesia.

Exclusion Criteria:

• Operations which will last for less than 15 minutes.
• Deep vein thrombosis in the upper extremities.
• History of radiotherapy or neck surgery.
• Previous sonographic data show tricuspid or mitral regurgitation or a very distended right atrium and ventricle.
• Patients with history of valvular or carotid artery surgery, arrhythmia, heart failure.
• Being unable to lie in a supine position for the necessary measurements.
• Technical limitations to imaging of the IJV and carotid artery.

Study Plan

How is the study designed?

Design Details

• Observational Models: Cohort
• Time Perspectives: Prospective

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Accuracy of IJV collapsibility index as predictor of Spinal anesthesia induced hypotension.	(Area under receiver operating characteristic curves)	10 minutes

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
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)	10 minutes
Incidence of Spinal anesthesia induced hypotension	Change in mean arterial blood pressure 25% less than the preoperative baseline level.	20 minutes
Carotid intima media thickness.	IMT is measured as the distance between lumen-intima and media-adventitia interfaces	10 minutes
Norepinephrine consumption	the total dose of norepiniphrine and number of boluses	20 minutes

Collaborators and Investigators

• Sponsor: Cairo University
• Investigators: Principal Investigator: Bassant abdelhamid, Cairo University

Publications and helpful links

General Publications

• Singh Y, Anand RK, Gupta S, Chowdhury SR, Maitra S, Baidya DK, Singh AK. Role of IVC collapsibility index to predict post spinal hypotension in pregnant women undergoing caesarean section. An observational trial. Saudi J Anaesth. 2019 Oct-Dec;13(4):312-317. doi: 10.4103/sja.SJA_27_19.
• Pre-operative ultrasonographic evaluation of inferior vena cava collapsibility index and caval aorta index as new predictors for hypotension after induction of spinal anaesthesia: A prospective observational study: erratum. Eur J Anaesthesiol. 2019 Nov;36(11):888. doi: 10.1097/EJA.0000000000001094. No abstract available.

Study record dates

Study Major Dates

• Study Start (Actual): October 7, 2021
• Primary Completion (Actual): November 10, 2021
• Study Completion (Actual): January 21, 2022

Study Registration Dates

• First Submitted: October 4, 2021
• First Submitted That Met QC Criteria: October 4, 2021
• First Posted (Actual): October 14, 2021

Study Record Updates

• Last Update Posted (Actual): February 21, 2022
• Last Update Submitted That Met QC Criteria: February 3, 2022
• Last Verified: February 1, 2022

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Cardiovascular Diseases; Vascular Diseases; Hypotension; Physiological Effects of Drugs; Central Nervous System Depressants; Anesthetics
• Other Study ID Numbers: MD-152-2020

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: Undecided

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No