Τίτλος:
The Utility of Echocardiography for the Prediction of Spinal-Induced Hypotension in Elderly Patients: Inferior Vena Cava Assessment Is a Key Player
Γλώσσες Τεκμηρίου:
Αγγλικά
Περίληψη:
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. © 2019 Elsevier Inc.
Συγγραφείς:
Saranteas, T.
Spiliotaki, H.
Koliantzaki, I.
Koutsomanolis, D.
Kopanaki, E.
Papadimos, T.
Kostopanagiotou, G.
Περιοδικό:
Journal of Cardiothoracic and Vascular Anesthesia
Λέξεις-κλειδιά:
antihypertensive agent; brain natriuretic peptide; ropivacaine, aged; area under the curve; arterial pressure; Article; atrial fibrillation; blood transfusion; body height; body mass; cardiovascular disease assessment; cohort analysis; diagnostic value; diastole; electrocardiogram; electrocardiography; fascia lata; female; femur fracture; flow rate; heart arrhythmia; heart atrium flutter; heart ejection fraction; heart left ventricle; heart rate; heart stroke volume; hip fracture; hip hemiarthroplasty; human; hypotension; hypothermia; induced hypotension; inferior cava vein; intraoperative period; leg amputation; length of stay; major clinical study; male; mean arterial pressure; measurement; medical history; multivariate logistic regression analysis; nausea; nerve block; oliguria; oxygen saturation; patella fracture; peripheral nerve; physical examination; postoperative care; postoperative hemorrhage; priority journal; prospective study; radial artery; receiver operating characteristic; recovery room; sciatic nerve; spinal anesthesia; systemic vascular resistance; tachycardia; transthoracic echocardiography; tricuspid annular plane systolic excursion; university hospital; visual analog scale; vomiting; X ray picture; blood pressure; diagnostic imaging; echocardiography; induced hypotension; inferior cava vein; pathophysiology; physiology; procedures; spinal anesthesia; very elderly, Aged; Aged, 80 and over; Anesthesia, Spinal; Blood Pressure; Cohort Studies; Echocardiography; Female; Humans; Hypotension, Controlled; Male; Prospective Studies; Vena Cava, Inferior
DOI:
10.1053/j.jvca.2019.02.032
