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Journal of Clinical Monitoring and Computing

, Volume 31, Issue 5, pp 919–926 | Cite as

Intraoperative TTE inferior vena cava monitoring in elderly orthopaedic patients with cardiac disease and spinal-induced hypotension

  • Theodosios SaranteasEmail author
  • Dimitrios Manikis
  • Thomas Papadimos
  • Andreas F. Mavrogenis
  • Georgia Kostopanagiotou
  • Fotios Panou
Original Research

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.

Keywords

TTE Inferior vena cava PACU Spinal anesthesia 

Abbreviations

ACC

American college of cardiology

AHA

American heart association

BMI

Body mass index

CVP

Central venous pressure

DBP

Diastolic blood pressure

EF

Ejection fraction

E

Expiration

HR

Heart rate

IVC

Inferior vena cava

I

Inspiration

IVCCI

Inferior vena cava collapsibility index

LV

Left ventricle

LOS

Length of stay

NYHA

New York heart association

PACU

Post-anesthesia care unit

PHE

Phenylephrine

PONV

Postoperative nausea and vomiting

RAP

Right atrial pressures

RV

Right ventricle

TAPSE

Tricuspid annular plane systolic excursion

TTE

Transthoracic echocardiography

Notes

Compliance with ethical standards

Conflict of interest

No benefits have been or will be received from a commercial party related directly or indirectly to the subject matter of this article. We wish also to confirm that there is no financial support for this work that could have influenced its outcome.

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Copyright information

© Springer Science+Business Media Dordrecht 2016

Authors and Affiliations

  • Theodosios Saranteas
    • 1
    • 5
    Email author
  • Dimitrios Manikis
    • 1
  • Thomas Papadimos
    • 4
  • Andreas F. Mavrogenis
    • 2
  • Georgia Kostopanagiotou
    • 1
  • Fotios Panou
    • 3
  1. 1.Second Department of AnesthesiologyAthens University Medical SchoolAthensGreece
  2. 2.First Department of OrthopaedicsAthens University Medical SchoolAthensGreece
  3. 3.Second Department of CardiologyAthens University Medical SchoolAthensGreece
  4. 4.Department of AnesthesiologyThe Ohio State University, Weaxner Medical CenterColumbusUSA
  5. 5.AthensGreece

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