Internal Jugular Vein Ultrasound for Predicting Hypotension in Geriatric Patients Undergoing Spinal Anesthesia

Официальное название

The Role of Internal Jugular Vein Ultrasonography in Predicting Hypotension in Geriatric Patients Undergoing Spinal Anesthesia: A Prospective Observational Study (Protocol ID: 2023-12/509)

Обзор

Spinal anesthesia-induced hypotension is a common and clinically significant complication in geriatric patients. Accurate preoperative assessment of intravascular volume status may help identify patients at risk. Internal jugular vein (IJV) ultrasonography is a noninvasive and easily applicable bedside method that reflects venous volume status. This prospective observational study aims to evaluate the role of preoperative IJV ultrasonographic measurements in predicting hypotension following spinal anesthesia in geriatric patients. Patients aged 65 years and older undergoing elective surgery under spinal anesthesia will be included. Preoperative IJV diameter, cross-sectional area, and collapsibility index will be measured using ultrasonography. Hemodynamic parameters will be monitored intraoperatively, and the occurrence of hypotension after spinal anesthesia will be recorded. The predictive value of IJV ultrasonographic parameters for post-spinal hypotension will be analyzed

Подробное описание

Spinal anesthesia is widely used in geriatric patients; however, hypotension following spinal anesthesia remains a frequent and clinically relevant complication in this population. Age-related physiological changes and reduced cardiovascular reserve increase susceptibility to hemodynamic instability. Therefore, identifying patients at risk of hypotension before spinal anesthesia is of clinical importance.

Assessment of intravascular volume status may contribute to predicting post-spinal hypotension. Ultrasonographic evaluation of the internal jugular vein (IJV) provides a noninvasive, bedside method reflecting venous filling and volume status. Parameters such as IJV diameter, cross-sectional area, and collapsibility index have been proposed as potential predictors of hypotension.

This prospective observational study will include patients aged 65 years and older undergoing elective surgery under spinal anesthesia. Preoperative ultrasonographic measurements of the IJV will be performed in the supine position prior to spinal anesthesia. Hemodynamic parameters, including systolic and diastolic blood pressure and heart rate, will be recorded before and after spinal anesthesia. Hypotension will be defined according to predefined criteria and documented during the intraoperative period.

The primary objective of the study is to evaluate the predictive value of preoperative IJV ultrasonographic measurements for hypotension following spinal anesthesia in geriatric patients.

Вмешательства

• Другое Not applicable- observational study
  Not applicable- observational study

Первичные конечные точки

• Post-spinal hypotension [Срок оценки: From spinal anesthesia administration up to 90 minutes intraoperatively.]

Критерии участия

Критерии включения

• Age ≥65 years
• Scheduled to undergo surgery under spinal anesthesia
• American Society of Anesthesiologists (ASA) physical status I-III
• Able and willing to provide written informed consent

Критерии исключения

• Did not provide written informed consent
• Undergoing emergency surgery
• Body mass index (BMI) ≥40 kg/m²
• Receiving angiotensin-converting enzyme (ACE) inhibitors
• Pre-spinal systolic blood pressure <90 mmHg or mean arterial pressure <70 mmHg
• Unable to tolerate the supine position
• Left ventricular ejection fraction <40%
• Requiring sedoanalgesia in addition to spinal anesthesia or conversion to general anesthesia

Критерии приведены из реестра в оригинале (на английском). Окончательную оценку соответствия проводит исследовательский центр.

Здоровые добровольцы: Да

Дизайн исследования

Модель наблюдения

Когортное

Центры проведения

Turkey (Türkiye) · 1 центр

• Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital — Ankara

Публикации

• Kaur K, Sara H, Duggal G, Depuru A, Reddy A, Bansal N. The Use of the Internal Jugular Vein Collapsibility Index (IJVCI) for the Prediction of Postspinal Hypotension in Geriatric Patients Posted for Lower Limb Surgeries. Cureus. 2025 Jan 2;17(1):e76824. doi: 10.7759/cureus.76824. eCollection 2025 Jan. PMID 39897318
• Klohr S, Roth R, Hofmann T, Rossaint R, Heesen M. Definitions of hypotension after spinal anaesthesia for caesarean section: literature search and application to parturients. Acta Anaesthesiol Scand. 2010 Sep;54(8):909-21. doi: 10.1111/j.1399-6576.2010.02239.x. Epub 2010 Apr 23. PMID 20455872
• N P, Sinha M, Kumar M, Ramchandani S, Khetrapal M, Karoo K, Mesa BK. Role of Internal Jugular Vein Collapsibility Index in Predicting Post-spinal Hypotension in Pregnant Women Undergoing Cesarean Section: A Prospective Observational Study. Cureus. 2023 May 23;15(5):e39389. doi: 10.7759/cureus.39389. eCollection 2023 May. PMID 37362461
• Wang MK, Piticaru J, Kappel C, Mikhaeil M, Mbuagbaw L, Rochwerg B. Internal jugular vein ultrasound for the diagnosis of hypovolemia and hypervolemia in acutely ill adults: a systematic review and meta-analysis. Intern Emerg Med. 2022 Aug;17(5):1521-1532. doi: 10.1007/s11739-022-03003-y. Epub 2022 Jun 20. PMID 35718838
• Tsui BC, Wagner A, Finucane B. Regional anaesthesia in the elderly: a clinical guide. Drugs Aging. 2004;21(14):895-910. doi: 10.2165/00002512-200421140-00001. PMID 15554749
• Critchley LA. Hypotension, subarachnoid block and the elderly patient. Anaesthesia. 1996 Dec;51(12):1139-43. doi: 10.1111/j.1365-2044.1996.tb15051.x. PMID 9038450
• Hartmann B, Junger A, Klasen J, Benson M, Jost A, Banzhaf A, Hempelmann G. The incidence and risk factors for hypotension after spinal anesthesia induction: an analysis with automated data collection. Anesth Analg. 2002 Jun;94(6):1521-9, table of contents. doi: 10.1097/00000539-200206000-00027. PMID 12032019
• Priebe HJ. The aged cardiovascular risk patient. Br J Anaesth. 2000 Nov;85(5):763-78. doi: 10.1093/bja/85.5.763. PMID 11094595

Идентификаторы

NCT: NCT07411313 · 2023-12/509

Первоисточники (государственные реестры)

• ClinicalTrials.gov (NIH, США)

Открыть это исследование на ClinicalTrials.gov ↗