IS CAVAL AORTIC INDEX A GOOD TOOL FOR PREOPERATIVE VOLEMIA ASSESSMENT?
DOI:
https://doi.org/10.32782/2411-9164.22.1-3Keywords:
anesthesia, spinal; aorta, abdominal; vena cava, inferior; hypotension, controlledAbstract
Introduction: Patient’s volemia assessment remains a challenge in anaesthetic management and is one of the causes of lack of control in Spinal Anesthesia Induced Hypotension (SAIH) prediction; however, Caval Aorta Index(IVC/Ao) measurement seems to be simple, fast and high-accuracy tool in evaluation of volemic status in elective orthopaedic surgery.Methods: Prospective, randomised study, performed on patients scheduled for elective anaesthesia in orthopaedic surgery; randomised into 2 groups: group 1 – patients with routine preloading with crystalloids; group 2 – patients with IVC/Ao evaluated ultrasonographically, and preloading at a Cut-off = 0.8. The outcome was appreciated by the incidence of hypotension after spinal anaesthesia in both groups. Results: BMI (p = 0.313) and age (p = 0.163) distribution by groups didn’t show a statistically significant difference in hypotension occurrence. Incidence of hypotension in both groups didn’t show significant statistical difference (p = 0.807).There was lack of association between hypotension occurrence and absence of preloading (Odds Ratio = 0.941, CI 95% 0.575 – 1.538).Conclusion: Caval Aorta Index represents a simple, fast, non-invasive, cost-effective method for volemia evaluation and it seems to be a good predictor of post-spinal anaesthesia hypotension.
References
McKenzie, P.J., Wishart, H.Y., Dewar, K.M.S., Gray, I., & Smith, G. (1980). Comparison of the effects of spinal anaesthesia and general anaesthesia on postoperative oxygenation and perioperative mortality. British Journal of Anaesthesia, 52(1), 49–54. https://doi.org/10.1093/bja/52.1.49
Brown, A.G., Visram, A.R., Jones, R., Irwin, M.G., & Bacon-Shone, J. (1994). Preoperative and postoperative oxygen saturation in the elderly following spinal or general anaesthesia – an audit of current practice. Anaesthesia and Intensive Care, 22(2), 150–154. https://doi.org/10.1177/0310057X9402200205
Hartmann, B., Junger, A., Klasen, J., Benson, M., Jost, A., Banzhaf, A., et al. (2002). The incidence and risk factors for hypotension after spinal anesthesia induction: An analysis with automated data collection. Anesthesia & Analgesia, 94(6), 1521–1529. https://doi.org/10.1213/00000539-200206000-00027
Vincent, J.-L., Pelosi, P., Pearse, R., Payen, D., Perel, A., Hoeft, A., et al. (2015). Perioperative cardiovascular monitoring of high-risk patients: A consensus of 12. Critical Care, 19(1), 224. https://doi.org/10.1186/s13054-015-0932-7
Sridhar, H., Mangalore, P., Chandrasekaran, V.P., & Manikam, R. (2012). Caval aorta index and central venous pressure correlation in assessing fluid status: «Ultrasound bridging the gap». ISRN Emergency Medicine, 2012, 1–5. https://doi.org/10.5402/2012/828626
Salama, E.R., & Elkashlan, M. (2019). Pre-operative ultrasonographic evaluation of inferior vena cava collapsibility index and caval aorta index as new predictors for hypotension after induction of spinal anaesthesia: A prospective observational study. European Journal of Anaesthesiology, 36(4), 297–302. https://doi.org/10.1097/eja.0000000000000956
Weir, C.B., & Jan, A. (2023). BMI classification percentile and cut off points. In StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. Available from: https://www.ncbi.nlm.nih.gov/books/NBK541070/
Ni, T.-T., Zhou, Z.-F., He, B., & Zhou, Q.-H. (2022). Inferior vena cava collapsibility index can predict hypotension and guide fluid management after spinal anesthesia. Frontiers in Surgery, 9, Article 831539. http://dx.doi.org/10.3389/fsurg.2022.831539
Zhang, J., & Critchley, L.A.H. (2016). Inferior vena cava ultrasonography before general anesthesia can predict hypotension after induction. Anesthesiology, 124(3), 580–589. https://doi.org/10.1097/aln.0000000000001002
Durajska, K., Januszkiewicz, E., Szmygel, Ł., & Kosiak, W. (2014). Inferior vena cava/aorta diameter index in the assessment of the body fluid status – a comparative study of measurements performed by experienced and inexperienced examiners in a group of young adults. Journal of Ultrasonography, 14(58), 273–279. https://doi.org/10.15557/jou.2014.0027
Gherasim, O., Casian, D., Cîvîrjic, I., Cernei, N., & Șandru, S. (2023). Hypotension in spinal anesthesia: Predictive factors, prevention and volemia’s non-invasive estimation methods. Moldovan Journal of Health Sciences, 4(10), 68–75. https://doi.org/10.52645/MJHS.2023.4.09
