Publication

Prevention of arterial hypotension after spinal anaesthesia using vena cava ultrasound to guide fluid management

Journal Paper/Review - Nov 23, 2017

Units
PubMed
Doi

Citation
Ceruti S, Anselmi L, Minotti B, Franceschini D, Aguirre J, Borgeat A, Saporito A. Prevention of arterial hypotension after spinal anaesthesia using vena cava ultrasound to guide fluid management. Br J Anaesth 2017; 120:101-108.
Type
Journal Paper/Review (English)
Journal
Br J Anaesth 2017; 120
Publication Date
Nov 23, 2017
Issn Electronic
1471-6771
Pages
101-108
Brief description/objective

BACKGROUND
Significant hypotension is frequent after spinal anaesthesia and fluid administration as therapy is usually empirical. Inferior vena cava (IVC) ultrasound (US) is effective to assess fluid responsiveness in critical care patients. The aim of this study was to evaluate the IVCUS-guided volume optimization to prevent post-spinal hypotension.

METHODS
In this prospective, randomized, cohort study, 160 patients scheduled for surgery under spinal anaesthesia were randomized into a study group (IVCUS-group), consisting of an IVCUS analysis before spinal anaesthesia with IVCUS-guided volume management and a control group (group C) with no IVCUS assessment. The primary outcome was a relative risk reduction in the incidence of hypotension between the groups; secondary outcomes were the need for vasoactive drugs and the amounts of fluids required after spinal anaesthesia. We also tested the hypothesis of a correlation between IVC collapsibility index and hypotension after spinal anaesthesia.

RESULTS
The relative risk reduction of hypotension between the groups was 35% (IVCUS-group 27.5%, Group C 42.5%, P=0.044, CI=95%). The need for vasoactive drugs in the IVCUS-group was significantly lower compared to the C-group (P=0.015), while the total amount of fluids was significantly superior higher in the IVCUS group (P<0.0001) compared to Group C. IVC collapsibility index was correlated with the amount of fluid administered (r=0.32), but could not be used to predict postspinal anaesthesia hypotension.

CONCLUSIONS
IVCUS is an effective method to prevent postspinal anaesthesia hypotension by IVCUS-guided fluid administration before spinal anaesthesia.

CLINICAL TRIAL REGISTRATION
www.clinicaltrials.gov - NCT02271477.