Autor:innen:
Samuele Ceruti (Genève | CH)
Mathieu Favre (Genève | CH)
Michele Musiari (Bellinzona | CH)
Bruno Minotti (St. Gallen | CH)
José Aguirre (Zürich | CH)
Luciano Anselmi (Bellinzona | CH)
Andrea Saporito (Bellinzona | CH)
Spinal anaesthesia is a safe procedure commonly used for a wide-ranging of surgical applications. One of the most common issues is arterial hypotension. Among the non-invasive methods for predicting and identifying fluid-responsive patients in spontaneous breath, there are currently two tests. The Passive Leg Raising Test (PLRT) consists in raising passively the patient's legs to increase venous return and therefore cardiac output. Ultrasound o f Inferior Vena Cava (IVC) is another useful test that analyses IVC’s variability during spontaneous breathing activity, which has been proven to be inaccurate in spontaneous ventilated critically ill patients, but there are little data in spontaneously breathing non-critical patients. Aim of this trial is to determine whether these two methods are effective in guiding fluid therapy both to reduce the rate of hypotension and fluid overload in non-critical patients.
Methods: This was a prospective, controlled, randomized, three-arm, parallel-group trial of consecutive patients undergoing elective surgery under spinal anaesthesia, randomized into three parallel groups. Inclusion criteria were spontaneously breathing adult patients of both sex, ASA-risk class I to III, undergoing an elective intervention under spinal anaesthesia. Primary outcome was the hypotension rate after spinal anaesthesia following fluid optimization therapy guided by IVCUS and PLRT test compared to empirical fluid administration.
Results: 484 consecutive patients were recruited (35 were excluded) and then randomized. The primary outcome about the hypotension rate shows 68 cases (46%) in the control group, 46 cases (35%) in the echo group and 65 cases (44%) in the PLRT group. Comparison the hypotension rates between the echo group and the control group, there is a reduction of 9% (p = 0.154), while among the echo group and the PLRT group there is a reduction of 11% (p = 0.086). The average amount of fluids administered to the patient between arrival under anesthesia and the onset of anesthesia is 141 ml for the control group, 336 ml for the echocardiography group and 168 ml for the PLRT group (p < 0.001). Globally the total amount of fluids administered is 453 ml for the control group, 593 ml for the echo group and 511 ml for the PLRT group, with significantly greater administration in the echocardiography group (p 0.01498).
Conclusion: IVC ultrasound seems to be a valid and safe method to reduce the rate of hypotension before spinal anesthesia.