Dissertation committee:
Σαραντέας Θεοδόσιος, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ, Επιβλέπων
Γερολουκά-Κωστοπαναγιώτου Γεωργία, Ομότιμη Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ, Συμβ. επιτροπή
Πικουλής Εμμανουήλ, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Σιδηροπούλου Τατιανή, Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ
Νάστος Κωνσταντίνος, Αναπληρωτής Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Μπριασούλης Παναγιώτης, Επίκουρος Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ, Συμβ. επιτροπή
Δελλαπόρτας Διονύσιος, Επίκουρος Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Summary:
Objectives: To prospectively assess the diagnostic performance of echocardiographic measurements before spinal anesthesia in elderly patients undergoing lower limb surgery. Emphasis was placed on the dIVCmax-to-IVCCI ratio and IVCCI, where dIVCmax was the maximum diameter of inferior vena cava (IVC) at expiration and IVCCI was the collapsibility index of IVC. Design: Open cohort, prospective, single-center study. Setting: University hospital. Interventions: A transthoracic echocardiography examination was performed in 70 patients before spinal anesthesia under standard criteria and protocol. Patients with intraoperative mean arterial pressure 65 mmHg or 25% reduction of its preoperative baseline were considered hypotensive. Measurements and Main Results: Preoperative echocardiographic measurements, including IVCCI, dIVCmax-to-IVCCI, ejection fraction, global longitudinal peak systolic strain, tricuspid annular plane systolic excursion, ratio of peak velocity flow in early diastole and average of peak velocities in early diastole of lateral and septal mitral annulus, stroke volume index, and left ventricle mass index were assessed. Twenty-eight of 70 patients manifested spinal-induced hypotension. Preoperative dIVCmax-to-IVCCI showed the greatest diagnostic performance among the indices. dIVCmax-to-IVCCI <43 had significantly higher diagnostic power than did IVCCI >0.3 (p = 0.032). Multiple logistic regression analysis revealed that the best predictors for spinal-induced hypotension were the dIVCmax-to-IVCCI ratio and age. Conclusions: The preoperative dIVCmax-to-IVCCI ratio can predict spinal-induced hypotension greater than IVCCI and other echocardiographic measurements in elderly patients. Both dIVCmax-to-IVCCI ratio and patient age can act as predictors of spinal-induced hypotension in elderly patients.
Keywords:
Transthoracic echocardiography, Predictive value of echocardiographic (US) parameters, Inferior vena cava. Spinal anesthesia. Intraoperative hypotension
