Inferior Vena Cava Collapsibility Index and Caval Aorta Index for Prediction of Hypotension General Anaesthesia
Accuracy of Preoperative Evaluation of Inferior Vena Cava Collapsibility Index and Caval Aorta Index for Prediction of Hypotension After Induction of General Anaesthesia: "A Prospective Observational Study"
- To estimate sensitivity and specificity of preoperative IVCCI, max aortic diameter and IVC:Ao index as predictors of hypotension after induction of general anesthesia.
- To compare accuracy of preoperative values of IVC: Ao index to preoperative IVCCI in prediction of hypotension after induction of general anesthesia.
研究概览
详细说明
After obtaining approval from the hospital ethics committee, informed consent will be obtained from 102 patients who will undergo elective surgery requiring general anaesthesia in supine position. Patients will be evaluated by history taking and proper examination. Pre-operative investigations will be checked. On the day of surgery, pre-operative fasting for 8 hours will be confirmed.
Upon arrival to the operating room, routine monitors in the form of pulse oximetry, electrocardiogarm and non-invasive blood pressure monitors will be applied. Intravenous line will be secured and routine premedications (ranitidine 50 mg and ondansetron 4 mg) will be administered.
IVC Ultrasonography (IVCCI and IVC:Ao index) :
While the patient is lying supine, the IVC and aorta will be examined before induction of general anaesthesia using a curved ultrasound transducer set to abdominal mode with a B-mode scan (1-5 MHz; Acuson x300; Siemens Healthcare, Seoul, Korea).
The transducer is placed in the subxiphoid region in a longitudinal position. IVC measurements are made just distal to the IVC-hepatic vein junction, approximately 3 to 4 cm distal to the right atrium. The IVC is identified by Doppler waveform, compressibility and phasic collapse with respiration. The maximum (IVCDmax) and minimum (IVCDmin) internal anteroposterior (AP) diameters of the IVC at the end of expiration and inspiration respectively over the same respiratory cycle will be measured. The IVCCI is derived from the equation: (7) IVCCI = [ (IVCDmax - IVCDmin) / IVCDmax ] X 100. To the left of the IVC, the abdominal aorta is visualized 10 mm above the coeliac trunk. The maximum internal AP diameter of the abdominal aorta is measured during systole. The IVC:Ao index is derived by taking the ratio of the maximum IVC diameter during expiration and the maximal abdominal aortic diameter during systole.
- Induction of anesthesia:
Standard noninvasive monitoring including ECG, noninvasive blood pressure (BP) measurements every minute and oxygen saturation will be applied. Heart rate (HR), SBP and MBP will be recorded immediately before general anaesthesia and will be defined as baseline readings.
General anaesthesia induction will be started using propofol intravenous anaesthetic (2 mg/kg) and Fentanyl (1 microgram/kg) and Atracrurium non-depolarizing muscle relaxant (0.5 mg/kg).Smooth endotracheal intubation with appropriate sized-cuffed endotracheal tube will be done after 3 mins of manual bag mask ventilation. Confirmation of endotracheal intubation will be done by 3 successive capnography waves and by bilateral lung auscultation. Meanwhile, the noninvasive BP will be recorded immediately after induction, then 5 and 10 minutes post induction, with continuous monitoring of other vital parameters (HR and oxygen saturation) during the postinduction period.
Any episode of hypotension (defined as mean arterial pressure < 80% of the baseline reading or or MAP less than 60 mmHg) will be managed by ephedrine 5 mg every 2 min to increase SBP to 80% of the baseline or MAP more than 70 mmHg. If the hypotensive episode persisted for 2 minutes, another bolus of norepinephrine will be administered. Any episodes of bradycardia (defined as heart rate less than 50 bpm) will be managed by atropine (0.01 mg/kg).
Patients will then be divided into two groups depending on whether they'll develop post general anesthesia induction hypotension or won't. Any complications, such as hypoxia or allergic reaction will be noted and managed accordingly.
The attending anesthesiologist who will perform the induction of general anaesthesia and monitor the patient during the study period will be blinded to the ultrasound measurements of IVCCI and IVC :Ao index recorded pre-operatively.
Measurement tools
- Mean arterial blood pressure will be measured in supine position in one of the upper limbs in the operating room at 1-minute intervals starting from the baseline preoperative reading until skin incision as follows: 1-minute post-induction reading, 2-minutes post-induction reading, pre-intubation reading & post-intubation readings until skin incision. Taking in consideration that the maximum time for recording the readings of the blood pressure is 15 minutes because if hypotension occurred after this time it is unlikely to be due to the effect of induction of anesthesia.
- Heart rate will be recorded at 1-minute intervals starting from the baseline pre-operative reading until skin incision as follows: 1-minute post-induction reading, 2-minutes post-induction reading, pre-intubation reading & post-intubation readings until skin incision.
- Demographic data: (age - gender - comorbidities - current medications).
- The incidence of post-induction hypotension.
- The incidence of bradycardia.
研究类型
注册 (实际的)
联系人和位置
学习地点
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Cairo、埃及、11562
- Kasr Alainy hospitals
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参与标准
资格标准
适合学习的年龄
接受健康志愿者
有资格学习的性别
取样方法
研究人群
描述
Inclusion Criteria:
- Patients aged 18 - 60 years old
- Patients undergoing elective surgery under general anesthesia.
- ASA I, II
Exclusion Criteria:
- Patients with BMI more than 35.
- Pregnant patients
- Emergency cases
- Patients with a baseline arterial SBP less than 90 mmHg or mean arterial pressure (MAP) less than 70 mmHg.
- Patients with major severe vascular disease, Unstable angina, Ejection fraction< 40 %, Respiratory distress, Implanted pacemaker or Patients on angiotensin converting enzyme inhibitors or angiotensin receptor blockers
- Patients with increased intra-abdominal pressure
学习计划
研究是如何设计的?
设计细节
- 观测模型:队列
- 时间观点:预期
研究衡量的是什么?
主要结果指标
结果测量 |
措施说明 |
大体时间 |
---|---|---|
Area under receiver operating characteristic curves (AUROC) of the preoperative IVCCI inprediction of post-induction hypotension
大体时间:5 minutes
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Area under receiver operating characteristic curves (AUROC) of the preoperative IVCCI inprediction of post-induction hypotension
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5 minutes
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次要结果测量
结果测量 |
措施说明 |
大体时间 |
---|---|---|
Correlation between each of maximum aortic diameter with the percentage of themaximum decrease in mean arterial pressure after induction of anesthesia
大体时间:5 minutes
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Correlation between each of maximum aortic diameter with the percentage of themaximum decrease in mean arterial pressure after induction of anesthesia
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5 minutes
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Correlation between each of IVC collapsibility index with the percentage of themaximum decrease in mean arterial pressure after induction of anesthesia
大体时间:5 minutes
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Correlation between each of IVC collapsibility index with the percentage of themaximum decrease in mean arterial pressure after induction of anesthesia
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5 minutes
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合作者和调查者
调查人员
- 研究主任:Heba Omar、associate professor of anesthesia and surgical ICU, faculty of medicine, Cairo university
出版物和有用的链接
一般刊物
- Zhang J, Critchley LA. Inferior Vena Cava Ultrasonography before General Anesthesia Can Predict Hypotension after Induction. Anesthesiology. 2016 Mar;124(3):580-9. doi: 10.1097/ALN.0000000000001002.
- Salama ER, Elkashlan M. 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. Eur J Anaesthesiol. 2019 Apr;36(4):297-302. doi: 10.1097/EJA.0000000000000956. Erratum In: Eur J Anaesthesiol. 2019 Nov;36(11):888.
研究记录日期
研究主要日期
学习开始 (实际的)
初级完成 (实际的)
研究完成 (实际的)
研究注册日期
首次提交
首先提交符合 QC 标准的
首次发布 (实际的)
研究记录更新
最后更新发布 (实际的)
上次提交的符合 QC 标准的更新
最后验证
更多信息
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