Assessment of vena cava inferior diameter with ultrasonography in patients undergoing spinal anesthesia and evaluation of postoperative hypotension

Year 2018, , 337 - 343, 30.10.2018

Ahmet Ozdemir Sinan Yilmaz , Mustafa Ogurlu

https://doi.org/10.17546/msd.463618

Abstract

Objective: Hypotension frequently occurs during spinal anesthesia and has serious complication that requires early and quick treatment. The goal of this study was to predict the state of fluids in the patient’s body through measurement via ultrasonography of the inferior vena cava diameter (IVCd) prior to administering the spinal anesthesia. This study also intended to investigate the presence or not of a relationship between the ultrasonography IVCd measurements before spinal anesthesia and hypotension. Material and Methods: A prospective study was performed in which the patients (n:115) were grouped based on their ultrasonography IVC transverse diameter measurements: those with <1.5 cm diameters were categorized as Group 1 (n:22), those having 1.5-2 cm diameter in Group 2 (n:67) and those possessing >2 cm diameter in Group 3 (n:26). The hemodynamic parameters of all the patients were measured. Results: Hypotension was observed in 23 (20%) patients, particularly in the 5th minute post administration of spinal anesthesia. Hypotension was especially high in Group 1 (52%) compared to Group 2 (34.8%) and Group 3 (13%) (p<0.001). Conclusion: We concluded that IVCd measurement with ultrasonography is a significant indicator which helps to determine the volumetric status of the patient. However, considering the development of the complication of hypotension post SA, it is felt that the IVC diameter measurement by USG might not always be adequate by itself, and needs to be assessed together with the clinical parameters of old age and presence of chronic diseases.

Keywords

hypotension, ultrasonography, anesthesia, vena cava inferior diameter

References

• 1. Mark JB, Steele SM. Cardiovascular effects of spinal anesthesia. Int Anesthesiol Clin 1989; 27(1):31-39.
• 2. Critchley LA, Short TG, Gin T. Hypotension during subarachnoid anaesthesia: haemodynamic analysis of three treatments. Br J Anaesth 1994; 72(2):151-155.
• 3. Esener Z: Lokal / Bolgesel Anestezi, Klinik Anestezi, Logos Yayıncılık, İstanbul 1991. S: 363-428.
• 4. Lyon M, Blaivas M, Brannam L. Sonographic measurement of the inferior vena cava as a marker of blood loss. Am J Emerg Med 2005;23 (1):45-50.
• 5. Gutierrez G, Reines HD, Wulf-Gutierrez ME. Clinical review: hemorrhagic shock. Crit Care 2004; 83 (5):373-81.
• 6. Çelebi Yamanoğlu NG, Yamanoğlu A, Parlak İ, Pınar P, Tosun A, Erkuran B, et al. The role of inferior vena cava diameter in volume status monitoring; the best sonographic measurement method? Am J Emerg Med 2015; 33 (3):433-8. doi: 10.1016/j.ajem.2014.12.014.
• 7. Bernards M.C. Spinal and epidural anesthesia. In: Bruce F Cullen, Robert K Stoelting, Paul G Barash., editors. Clinical Anesthesia, 5th edn. .Lippincot Williams&Wilkins; 2006. pp. 691-717.
• 8. Regional anesthesia & Pain management. In: Butterworth, J. F., Mackey, D. C., Wasnick, J. D., Morgan, G. E., & Mikhail, M. S (Eds). Morgan & Mikhail's Clinical Anesthesiology, 5th edn. New York: McGraw-Hill; 2013. p.937-974.
• 9. Kaye AD, Riopelle JM. Intravascular fluid and electrolyte physiology. In: Miller RD, editor. Miller’s anesthesia. 6th ed. Philadelphia (US): Elsevier; 2005. pp. 1705–1737.
• 10. Barash PG, Cullen BF, Stoelting RK, Cahalan MK, Stock MC. Clinical Anesthesia. 6th ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2009.
• 11. Hernandez CA, Reed KL, Juneman EB, Cohen WR. Changes in Sonographically Measured Inferior Vena Caval Diameter in Response to Fluid Loading in Term Pregnancy. J Ultrasound Med 2016; 35 (2):389-94. doi: 10.7863/ultra.15.04036.
• 12. Taivainen T. Comparison of ephedrine and etilefrine for the treatment of arterial hypotension during spinal anaesthesia in elderly patients. Acta Anaesthesiol Scand 1991; 35:164-169.
• 13. Kusaba T, Yamaguchi K, Oda H. Echography of the inferior vena cava for estimating fluid removal from patients undergoing hemodialysis. Jpn J Nephrol 1994; 36 (8):914-920.
• 14. Wallace DJ, Allison M, Stone MB. Inferior vena cava percentage collapse during respiration is affected by the sampling location: an ultrasound study in healthy volunteers. Acad Emerg Med 2010; 17(1):96-9. doi: 10.1111/j.1553-2712.2009.00627.x.
• 15. Masugata H, Senda S, Okuyama H, Murao K, Inukai M, Hosomi N et al. Age-related decrease in inferior vena cava diameter measured with echocardiography. Tohoku J Exp Med 2010; 222 (2):141-7.
• 16. Anatomy and phsiology. Chapter 26. Fluid, electrolyte and acid base balance.https://opentextbc.ca/anatomy and phsiology
• 17. Racle JP, Poy JY, Haberer JP, Benkhadra A. A comparison of cardiovascular responses of normotensive and hypertensive elderly patients following bupivacaine spinal anesthesia. Reg Anesth 1989;14(2):66-71.
• 18. McAnulty GR, Robertshaw HJ, Hall GM. Anaesthetic management of patients with diabetes mellitus. Br J Anaesth 2000; 85(1):80-90.
• 19. Zengin S, Al B, Genc S, Yildirim C, Ercan S, Dogan M et al. Role of inferior vena cava and right ventricular diameter in assessment of volume status: a comparative study: ultrasound and hypovolemia. Am J Emerg Med 2013; 31(5):763-7. doi: 10.1016/j.ajem.2012.10.013.
• 20. Tetsuka T, Ando Y, Ono S, Asano Y. Change in inferior vena caval diameter detected by ultrasonography during and after hemodialysis. ASAIO J 1995; 41(1):105-110.
• 21. Cheriex EC, Leunissen KM, Janssen JH, Mooy JM, van Hooff JP et al. Echography of the inferior vena cava is a simple and reliable tool for estimation of 'dry weight' in haemodialysis patients. Nephrol Dial Transplant 1989; 4(6):563-568.
• 22. 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(8):1414-1419.e1. doi: 10.1016/j.ajem.2011.10.017.
• 23. Hutchings S, Bisset L, Cantillon L, Keating-Brown P, Jeffreys S, Muzvidziwa C, et al. Nurse-delivered focused echocardiography to determine intravascular volume status in a deployed maritime critical care unit. J R Nav Med Serv2015; 101(2):124-128.
• 24. Veering BT. Hemodynamic effects of central neural blockade in elderly patients.Can J Anaesth 2006;53(2):117-121.
• 25. Buggy D, Higgins P, Moran C, O'Brien D, O'Donovan F, McCarroll M. Prevention of spinal anesthesia-induced hypotension in the elderly: comparison between preanesthetic administration of crystalloids, colloids, and no prehydration. Anesth Analg 1997; 84 (1):106-110.
• 26. Altıntaş F, Tunalı Y, Utku T, Bozkurt P, Kaya G, Köse Y. Spinal Anestezide Bupivakain + Neostigmin Uygulaması. Türk Anest Rean Mecmuası 1997; 25: 313-317.
• 27. Carpenter RL, Caolan RA, Brown DL, Stephenson C, Wu R. Incidence and risk factors for side effects of spinal anesthesia. Anesthesiology 1992; 76(6): 906-916.