Ultrasonographic Assessment of Neck Vessels as Predictors of Spinal Anesthesia Induced Hypotension in Elderly
Condition: Post-spinal Hypotension
MeSH terms: Hypotension
Study type: Observational [Patient Registry]

Summary: 
      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.
    

Detailed description: 
      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.
    

Intervention name(s): IJV Ultrasonography; Carotid Intima Media Thickness; Spinal anesthesia
Intervention type(s): Device; Device; Procedure
Intervention description(s): Patient will be in supine position, The linear probe with frequency of 7- 12 M hz; depth of 3 cm. maximum IJV diameter (IJV-D) and area (IJV-A) will be recorded. M-mode will be used to obtain the distance between the 2 walls of the vein during inspiration and expiration.
Then, the patient will be positioned 10° Trendelenburg and similar ultrasonographic measurements will be again performed; US Probe is slided superiorly (toward the head) or inferiorly (toward the feet) until the bifurcation of the common carotid artery (CCA) appears on the left side of the screen. This is the ideal location for imaging and CIMT measurements.
IMT is assessed in longitudinal view from the arterial far wall, along a 10mm length. CIMT will appear as two parallel lines (leading edges of two anatomical boundaries) from it: lumen- intima and media- adventitia interfaces perpendicular to ultrasound beams.; Spinal anesthesia will be performed in the sitting position at level of L3-4 or L4- 5 interspaces with a 25-gauge spinal needle. Local infiltration of skin and subcutaneous tissue with 2% lignocaine will be applied. After confirming cerebrospinal fluid flow, 10 mg of 0.5% hyperbaric bupivacaine plus 25 mcg fentanyl will be injected. The degree of sensory block (cold test by alcohol gauze) will be assessed in the study with a goal of T8 dermatomal level block.
Intervention MeSH terms: Anesthetics
Observational model: Cohort
Time perspective: Prospective
Sampling method: Probability Sample
Study population: 
        Participants will be elderly patients (above 60 years), ASA I-II-III, scheduled for
        elective surgeries under spinal anesthesia.