title: Intraoperative TTE inferior vena cava monitoring in elderly orthopaedic patients with cardiac disease and spinal-induced hypotension.
abstract: Objective To address the role of transthoracic echocardiography in inferior vena cava (IVC) monitoring in the management of haemodynamically unstable elderly patients subjected to lower limb orthopaedic surgery under spinal anesthesia. Possible implications in the postoperative care unit (PACU) length of stay (LOS) are investigated. Methods 41 elderly patients with cardiac diseases were recruited. Patients experiencing intraoperative haemodynamic instability (diastolic blood pressure ≤ 60 mmHg) were divided into two groups according to right atrial pressure (RAP), (RAP < 5 mmHg and RAP between 5 and 10 mmHg) as measured by inferior vena cava collapsibility index (IVCCI). Haemodynamic instability was treated with normal saline infused at a constant rate supplemented by phenylephrine (PHE) infusions titrated to normal blood pressure values. Intraoperatively comparisons of peak PHE infusion rates and all episodes of hypotension, including in the PACU, were recorded among groups. The patients' PACU LOS and associated factors were assessed. Results The intraoperative peak PHE infusion rate and the incidence of haemodynamic instability in the postoperative period were significantly higher in patients with RAP < 5 mmHg. The total PHE consumption was also higher in patients with RAP < 5 mmHg postoperatively. The primary risk factor for a prolonged stay in PACU, as determined by multiple regression analysis was RAP. Conclusions Patients with high dynamic collapsibility of the IVC may require aggressive treatment to restore their haemodynamic status. Additionally, intraoperative levels of RAP, as measured by IVCCI, can act as a predictor for increased LOS in the PACU.
authors: Second Department of Anesthesiology, Athens University Medical School, Athens, Greece. thsaranteas@gmail.com.|, 14, Kerdillion Str, Gerakas, Athens, Greece. thsaranteas@gmail.com.
authors: Theodosios
authors: T
authors: Saranteas
authors: Second Department of Anesthesiology, Athens University Medical School, Athens, Greece.
authors: Dimitrios
authors: D
authors: Manikis
authors: Department of Anesthesiology, The Ohio State University, Weaxner Medical Center, Columbus, OH, USA.
authors: Thomas
authors: T
authors: Papadimos
authors: First Department of Orthopaedics, Athens University Medical School, Athens, Greece.
authors: Andreas F
authors: AF
authors: Mavrogenis
authors: Second Department of Anesthesiology, Athens University Medical School, Athens, Greece.
authors: Georgia
authors: G
authors: Kostopanagiotou
authors: Second Department of Cardiology, Athens University Medical School, Athens, Greece.
authors: Fotios
authors: F
authors: Panou
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure / Q000502:physiology*; D006328:Cardiac Catheterization; D004452:Echocardiography / Q000295:instrumentation* / Q000379:methods; D005260:Female; D006331:Heart Diseases; D006439:Hemodynamics; D006801:Humans; D008297:Male; D016343:Monitoring, Intraoperative / Q000295:instrumentation* / Q000379:methods; D019637:Orthopedic Procedures; D011446:Prospective Studies; D014682:Vena Cava, Inferior / Q000000981:diagnostic imaging*
keywords: Inferior vena cava; PACU; Spinal anesthesia; TTE