Caval-aorta Index and Perfusion Index on Predict Hypotension After Spinal Anaesthesia in Elderly

Can Caval-aorta Index and Perfusion Index Predict Hypotension After Spinal Anaesthesia in Elderly Patients Undergoing Lower Extremity Surgery?

The aim of our study was to predict hypotension by using caval aorta index and perfusion index in elderly patients who may develop hypotension after spinal anesthesia.

Study Overview

• Status: Completed
• Conditions: Anesthesia, Spinal
• Intervention / Treatment: Device: ultrasonography to measure the index of the caval aorta and non-invasive pulse oximetry for perfusion index

Detailed Description

The study will include 200 patients over 60 years of age who are planned to undergo elective lower extremity surgery in the supine position with spinal anaesthesia. This study is planned as a single-centre prospective observational study. All patients planned to be included in the study will be fasted according to the standard protocol. Age, height, body weight, body mass index, gender, type of surgery, systemic disease, preoperative heart rate (HR), noninvasive systolic (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP) and peripheral oxygen saturation (SpO₂) will be measured and noted in the waiting area before entering the operating room. For the initial perfusion index (PI) value, PI measurement will be taken 3 times at 5 minutes intervals with a probe to be attached to the same finger and the average will be recorded as the initial PI value. To measure the IVC diameter, the maximum internal AP diameter of the IVC will be measured in M-mode during expiration and the mean will be taken. The maximum internal AP diameter of the abdominal aorta will be measured during systole and the mean will be recorded as the aortic diameter.The study will be explained to all patients participating in the study and informed consent will be obtained from the patients. Routine preoperative preparations and monitoring of the patients admitted to the operating room will be performed. Spinal anaesthesia will be performed through L3-4 or L4-5 intervertebral spaces in the sitting position.Depending on the nature of the patient and the type of surgery, an appropriate dose of 0.5% hyperbaric bupivacaine will be injected intrathecally to provide adequate sensory block.The patient will be immediately placed in the supine position.The level of sensory blockade will be evaluated at the end of the appropriate time. heart rate, systolic, diastolic blood pressure, mean arterial pressure, oxygen saturation and PI will be recorded every 2 minutes for the first 15 minutes, then every 5 minutes until the 30th minute, then every 10 minutes until the 60th minute and at the end of the operation.Hypotension after spinal anaesthesia will be defined as SDB less than 90 mmHg, a fall in SDB by more than 30% from the preoperative baseline value or an OAB less than 60 mmHg.Patients will be divided into two groups as patients with and without hypotension after spinal anaesthesia. Demographic data (age, gender, comorbidity, etc.), caval-aorta index and PI will be analysed for differences between the groups.

The primary aim of the study was to evaluate the ability of caval-aorta index and PI to predict post-spinal hypotension in elderly patients between the two groups.

• Study Type: Observational
• Enrollment (Actual): 200

Contacts and Locations

Study Locations

• Turkey (Türkiye)
  • Ankara, Çankaya, Turkey, 06800
    • Ankara, Ankara, Çankaya, Turkey, 06800, Turkey (Türkiye), 06800
      • Ankara Bilkent City Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: Yes

• Sampling Method: Probability Sample

Study Population

patients over 60 years of age who will undergo elective lower extremity surgery in supine position admitted to ankara city hospital

Description

Inclusion Criteria:

• American Society of Anesthesiology(ASA) I-II-III score
• Patients over 60 years
• Elective surgeries
• Surgeries in supine position

Exclusion Criteria:

• Patient refusal to participate in the study
• The patient will undergo emergency surgery
• Contraindication to spinal anaesthesia
• Planning unilateral spinal anaesthesia
• Failure of spinal anaesthesia
• Body mass index above 35kg/m2
• Presence of preoperative hypotension (SBP<90mmHg or MAP<60mmHg)
• The patient has valvular disease and arrhythmia impairing haemodynamics
• Presence of neuropsychiatric disorders that make communication difficult
• Presence of abdominal hernia

Study Plan

How is the study designed?

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
patients with spinal induced hypotension; patients with hypotension after spinal anesthesia (SBP less than 90 mmHg, a decrease in SBP by more than 30% from the preoperative baseline value, or an MAP below 60 mmHg)	Device: ultrasonography to measure the index of the caval aorta and non-invasive pulse oximetry for perfusion index; Inferior vena cava and aortic diameter measurements will be made by ultrasonography and perfusion index determination using non-invasive pulse oximetry
patients without spinal induced hypotension	Device: ultrasonography to measure the index of the caval aorta and non-invasive pulse oximetry for perfusion index; Inferior vena cava and aortic diameter measurements will be made by ultrasonography and perfusion index determination using non-invasive pulse oximetry

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
caval aorta index for predicting hypotension in the elderly	to determine the threshold value for the caval aorta index in determining hypotension using logistic regression analysis	1 hour

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
systolic blood pressure	recorded preoperatively and in the operating room every 2 minutes for the first 15 minutes, then every 5 minutes until the 30th minute, then every 10 minutes until the 60th minute and at the end of the operation	1 hour
diastolic blood pressure	recorded preoperatively and in the operating room every 2 minutes for the first 15 minutes, then every 5 minutes until the 30th minute, then every 10 minutes until the 60th minute and at the end of the operation	1 hour
mean arterial pressure	recorded preoperatively and in the operating room every 2 minutes for the first 15 minutes, then every 5 minutes until the 30th minute, then every 10 minutes until the 60th minute and at the end of the operation	1 hour
hearth rate	recorded preoperatively and in the operating room every 2 minutes for the first 15 minutes, then every 5 minutes until the 30th minute, then every 10 minutes until the 60th minute and at the end of the operation	1 hour
oxygen saturation	recorded every 2 minutes for the first 15 minutes, then every 5 minutes until the 30th minute, then every 10 minutes until the 60th minute and at the end of the operation	1 hour
T10 dermatome	time to reach T10 dermatome level	1 hour
dermatomal level	the highest dermatome level achieved with spinal anesthesia	1 hour
use ephedrine	dose of ephedrine used	1 hour
bromage scale motor blocage score	bromage scale score is a score between 0 and 3. bromage 0 means full movement of the leg and knee, bromage 3 means full motor blockade of the legs. the time to reach bromage 3 will be recorded	1 hour
perfusion index for predicting hypotension in the elderly	to determine the threshold value for the perfusion index in determining hypotension using logistic regression analysis	1 hour
inferior vena cava diameter for predicting hypotension in the elderly	to determine the threshold value for the inferior vena cava diameter in determining hypotension using logistic regression analysis	1 hour
abdominal aort diameter for predicting hypotension in the elderly	To determine the effect of abdominal aort diameter on the prediction of hypotension using logistic regression analysis.	1 hour

Collaborators and Investigators

• Sponsor: Ankara City Hospital Bilkent

Study record dates

Study Major Dates

• Study Start (Actual): July 1, 2024
• Primary Completion (Actual): April 15, 2025
• Study Completion (Actual): May 25, 2025

Study Registration Dates

• First Submitted: June 24, 2024
• First Submitted That Met QC Criteria: June 24, 2024
• First Posted (Actual): June 28, 2024

Study Record Updates

• Last Update Posted (Actual): December 26, 2025
• Last Update Submitted That Met QC Criteria: December 19, 2025
• Last Verified: December 1, 2025

More Information

Terms related to this study

• Keywords: spinal anesthesia; orthopedic surgery; perfusion index; elderly patients; caval aorta index
• Additional Relevant MeSH Terms: Cardiovascular Diseases; Vascular Diseases; Hypotension; Diagnostic Techniques and Procedures; Diagnosis; Diagnostic Techniques, Cardiovascular; Perfusion Index
• Other Study ID Numbers: spinal-induced hypotension

Plan for Individual participant data (IPD)

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

Drug and device information, study documents

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