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

S Ceruti, L Anselmi, Bruno Minotti, D Franceschini, J Aguirre, A Borgeat & A Saporito

abstract

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.
   
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)
date of publishing 23-11-2017
journal title Br J Anaesth (120/1)
ISSN electronic 1471-6771
pages 101-108
PubMed 29397116
DOI 10.1016/j.bja.2017.08.001