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Background and Aims Hip fractures(HF) in the elderly over 70years old have significant impacts on quality life. Spinal anesthesia(SA) is the main approach for HF surgical synthesis, but its mayor complication is hypotension. The aim of this study is to determine if Iliac Vein(IV) collapsibility predicts hypotension comparing Inferior Cava Vein(ICV), using PoCUS which provides rapid diagnostic information and real-time monitoring at the bedside.
Methods Patients with HF over 70years with BMI≤30 and ASA II-III were enrolled. Internal diameters of IVC and IV were measured at the end of expiration and inspiration in the same respiratory cycle. No fluid preload was infused to any patient before SA. Standard noninvasive monitoring including NIBP was recorded. SA was performed at L3-L4 level injecting Levobupivacaine 0.5%(12-15mg) as local anesthetic. Hypotension was defined as SBP<90mmHg, MAP<60mmHg, or 30% reduction in baseline SBP. Hypotension was treated with vasopressors or fluids according to anesthesiologist.
Results 55 patients (table 1) were enrolled and divided into Hypo-group (hypotension after SA) and NO Hypo-group (no hypotension). The average collapsibility of ICV as well as IV was significantly higher in the Hypo-group(image2). Analysis showed a systolic pattern of hypotension(Image3). The ROC showed high predictive value for ICV (AUC:0.974) as well as IV (AUC:0.985) collapsibility.
Conclusions Our intent was to compare the predictive value of IV versus ICV collapsibility in assessing the risk of hypotension following SA in elderly patients with HF. PoCUS approach allows anesthesiologists to measure preoperative IV collapsibility easier than ICV, providing them the possibility to predict hypotension risk after SA, even in the operating theater.
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