The relationship between collapsibility index of inferior vena cava and hypotension after spinal anesthesia

Year 2021, , 319 - 325, 04.05.2021

Serra Topal , Derya Karasu , Canan Yılmaz , Çağdaş Baytar , Erhan Tenekecioğlu , Dursun Topal

https://doi.org/10.18621/eurj.739559

Abstract

Objectives: Hypotension is a common complication of spinal anesthesia. Imaging of inferior vena cava (IVC) and measurement of the IVC-collapsibility index (IVC-CI) by ultrasonography (USG) has been a widely used non-invasive, easy and reliable method for measurement of the fluid imbalance. In the present study, we aimed to investigate the predictive ability of the maximum IVC diameter (dIVCmax) and IVC-CI for hypotension after spinal anesthesia.

Methods: The study was designed as prospective and observational. One hundred thirty-two patients aged 18-75 years with ASA I-II underwent inguinal hernia surgery with spinal anesthesia and recruited to the study. Maximum and minimum (dIVCmin) IVC diameters were measured. IVC-CI (%) was quantified according to the formula of [(dIVCmax - dIVCmin)/dIVKmax] × 100%.

Results: The patients were grouped as hypotensive and non-hypotensive. In fifty-seven patients of 120 cases (47.5%), hypotension has emerged following spinal anesthesia. No significant differences in dIVCmax and IVC-CI were recorded between the study groups (p > 0.05). There were significant inverse correlation between age and IVC-CI. Significant positive correlation between the lowest values of the systolic arterial pressure, diastolic arterial pressure, mean arterial pressure and IVC-CI and significant positive correlation between dIVCmax and diastolic blood pressure, maximum and minimum values of the mean arterial pressure.

Conclusions: We found that dIVCmax and IVC-CI values measured before spinal anesthesia were not sufficient parameters enough to predict hypotension after spinal anesthesia. Further studies investigating the IVC measurements under spinal anesthesia together with dynamic hemodynamic monitorization modalities are needed.

Keywords

Hypotension, inferior vena cava, inferior vena cava collapsibility index, spinal anesthesia, ultrasonography

References

• 1. Lee JE, George RB, Habib AS. Spinal-induced hypotension: Incidence, mechanisms, prophylaxis, and management: summarizing 20 years of research. Best Pract Res Clin Anaesthesiol 2017;31:57-68.
• 2. Baraka A, Taha S, Ghabach M, Sibaii A, Nader A, Matta M. Hypertonic saline prehydration in patients undergoing transurethral resection of the prostate under spinal anaesthesia. Br J Anaesth 1994;72:227-8.
• 3. Shimosato S, Etsten BE. The role of the venous system in cardiocirculatory dynamics during spinal and epidural anesthesia in man. Anesthesiology 1969;30:619-28.
• 4. Critchley LAH, Short TG, Gin T. Hypotension during subarachnoid anaesthesia: haemodynamic analysis of three treatments. Br J Anaesth 1994;72:151-5.
• 5. Dipti A, Soucy Z, Surana A, Chandra S. Role of inferior vena cava diameter in assessment of volume status: a meta-analysis. Am J Emerg Med 2012;30:1414-9.e1.
• 6. Brennan JM, Blair JE, Goonewardena S, Ronan A, Shah D, Vasaiwala S, et al. Reappraisal of the use of inferior vena cava for estimating right atrial pressure. J Am Soc Echocardiogr 2007;20:857-61.
• 7. Brennan JM, Ronan A, Goonewardena S, Blar JEA, Hammes M, Shah D, et al. Handcarried ultrasound measurement of the inferior vena 
cava for assessment of intravascular volume status in the outpatient hemodialysis clinic. Clin J Am Soc Nephrol 2006;1:749-53.
• 8. Seif D, Mailhot T, Perera P, Mandavia D. Caval sonography in shock: a noninvasive method for evaluating intravascular volume in critically ill patients. J Ultrasound Med 2012;31:1885-90.
• 9. Wong SP . In Otto CM (ed.), Textbook Clinical Echocardiography, 2nd. Ed., Philadelphia: WB Saunders, 2000.
• 10. Ceruti S, Anselmi L, Minotti D, Franceschini D, Aguirre J, Borgoet A, et al. Prevention of arterial hypotension after spinal anaesthesia using vena cava ultrasound to guide fluid management. Br J Anaesth 2018;120:101-8.
• 11. Zhang J, Critchley LAH. Inferior vena cava ultrasonography before general anesthesia can predict hypotension after induction. Anesthesiology 2016;124:580-9.
• 12. Bijker JB, van Klei WA, Kappen TH, van Wolfswinkel L, Moons KGM, Kalkman CJ. Incidence of intraoperative hypotension as a function of the chosen definition. Anesthesiology 2007;107:213-20.
• 13. Hartmann B, Junger A, Klasen J, Benson M, Jost A, Banzhaf A, et al. The incidence and risk factors for hypotension after spinal anaesthesia induction: an analysis with automated data collection. Anesth Analg 2002;94:1521-9.
• 14. McCrae AF, Wildsmith JA. Prevention and treatment of hypotension during central neural block. Br J Anaesth 1993;70:672-80.