Ultrasonographic Assessment of Neck Vessels as Predictors of Spinal Anesthesia Induced Hypotension in Elderly

Pre-anesthetic Ultrasonographic Assessment of Neck Vessels as Predictors of Spinal Anesthesia Induced Hypotension in Elderly: a Prospective Observational Study.

Spinal anesthesia induces sympathetic blockade and venodilation, thus reducing venous return and the cardiac output. Therefore, assessment of intravascular volume deficit before anesthesia might predict a critical decrease in blood pressure after anesthesia.

Recently, ultrasonographic evaluation of the internal jugular vein (IJV) has been used to reflect intravascular volume status and fluid and as a predictor of hypotension after induction of general anesthesia.

Carotid intima-media thickness (CIMT) has been used to predict atherosclerosis-related events, such as stroke, myocardial infarction, peripheral artery disease, and hypotension after induction of anesthesia with a cut-off value of 0.65 mm of CIMT as a threshold level.

This study aims to evaluate the ability of preoperative Ultrasonographic assessment of the internal jugular vein (IJV) and Carotid intima-media thickness (CIMT) to predict spinal anesthesia induced hypotension (SAIH).

Participants will be elderly patients (above 60 years), ASA I-II-III, scheduled for elective surgeries under spinal anesthesia.

Inclusion Criteria:

• Adult patients (>60 years)
• ASA I-II-III
• Patients scheduled for elective surgeries under spinal anesthesia.

Exclusion Criteria:

• Operations which will last for less than 15 minutes.
• Deep vein thrombosis in the upper extremities.
• History of radiotherapy or neck surgery.
• Previous sonographic data show tricuspid or mitral regurgitation or a very distended right atrium and ventricle.
• Patients with history of valvular or carotid artery surgery, arrhythmia, heart failure.
• Being unable to lie in a supine position for the necessary measurements.
• Technical limitations to imaging of the IJV and carotid artery.