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

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)

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

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.

Inclusion Criteria:

• 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

Exclusion Criteria:

• 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