Delta Inferior Vena Cava Index Correlated with Mean Arterial Pressure (MAP) in Spinal Anesthesia

Background: Spinal anesthesia has become an alternative to general anesthesia. However, spinal anesthesia has the most common side effects including, bradycardia and hypotension. The aim of this study was to determine the relationship between changes in the inferior vena cava index (delta inferior vena cava index) to changes in mean arterial pressure in spinal anesthesia. Methods: This study was an observational pre-post test study in thirty-two patients who received spinal anesthesia. The inferior vena cava index (inferior vena cava collectibility index and caval-aorta index) was measured before and after spinal anesthesia (5 and 10 minutes after onset). Data were analyzed using the Kolmogorov Smirnov test, Shapiro-Wilk test, T-test, and correlation test with α=5% Result: There was a significant difference in mean arterial pressure (MAP), delta inferior vena cava collectibility index (D-IVC-CI), and delta caval-aorta index (D-CAo-I) before and after spinal anesthesia. D-IVC-CI and D-CAo-I are significantly correlated with MAP. The correlation between D-IVC-CI and MAP had R = -0.371 (P <0.05) at 5 minutes post-anesthesia, while D-CAo-I and MAP had R = 0.472 (P <0.05) at 10 minutes post-anesthesia. Conclusion: The delta inferior vena cava index is correlated with the mean arterial pressure (MAP) value in spinal anesthesia.

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Role of the liver in long-term control of drinking behavior, Na+ balance, and arterial pressure in Dahl rats

AJP Regulatory Integrative and Comparative Physiology ◽

10.1152/ajpregu.1998.274.4.r1111 ◽

1998 ◽

Vol 274 (4) ◽

pp. R1111-R1118 ◽

Cited By ~ 4

Author(s):

Hironobu Morita ◽

Kiyoshi Tsunooka ◽

Masanobu Hagiike ◽

Osamu Yamaguchi ◽

Ken Lee

Keyword(s):

Mean Arterial Pressure ◽

Inferior Vena Cava ◽

Arterial Pressure ◽

Significant Role ◽

Inferior Vena ◽

Dark Period ◽

Drinking Behavior ◽

Vena Cava

The role of postabsorptive mechanisms in long-term control of drinking behavior, Na+ balance, and arterial pressure was examined in Dahl salt-sensitive (DS) and salt-resistant (DR) rats. NaCl (0.15 M) was infused (0.5 ml/h) into either the inferior vena cava (IVC) or the portal vein (PV) for 7 days, and then 1.5 M NaCl was infused for 10 days. During 1.5 M infusion, the IVC group retained more Na+ than the PV group. Furthermore, in DS rats, mean arterial pressure was higher in the IVC group than in the PV group. Regardless of the strain and infusion route, 1.5 M infusion had no effect on volume of daily saline consumption. However, when the data for light and dark periods were analyzed separately, dark period saline consumption in the PV group was decreased by 1.5 M infusion but was not changed in the IVC group. These results indicate that, in Dahl rats, the postabsorptive mechanism plays a significant role in controlling long-term saline drinking behavior and Na+ balance and has a significant role in controlling arterial pressure in DS, but not DR, rats.

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The Effects of Positional Change on Hemodynamic Parameters in Spinal Immobilization

Prehospital and Disaster Medicine ◽

10.1017/s1049023x20001338 ◽

2020 ◽

pp. 1-7

Author(s):

Emre Gökçen ◽

Vahit Demir

Keyword(s):

Inferior Vena Cava ◽

Arterial Pressure ◽

Inferior Vena ◽

Vena Cava ◽

Left Ventricular ◽

Trauma Patients ◽

Hemodynamic Parameters ◽

Study Objective ◽

Spinal Immobilization ◽

Significant Difference

Abstract Introduction: The use of a long backboard and cervical collar are commonly recommended by international guidelines for spinal immobilization, but both devices may cause several side effects. In a recent study, it was reported that spinal immobilization at 20° eliminated the decrease in pulmonary function secondary to spinal immobilization performed at 0°. Spinal immobilization at 20° is a new recommendation, but other potential effects need to be explored before it can be implemented in clinical use. Study Objective: Hemodynamic observation is important in the management of trauma patients. The aim of this study was to investigate the effect of spinal immobilization at a 20° position instead of 0° on hemodynamic parameters. Methods: This study included 53 healthy volunteers who underwent spinal immobilization in the supine position (00) and in an elevated position (200). Systolic arterial pressure (SAP), diastolic arterial pressure (DAP), mean arterial pressure (MAP), heart rate (HR), left ventricular outflow tract velocity time integral (LVOT-VTI), left ventricular stroke volume (LVSV), cardiac output (CO), inferior vena cava diameter inspiration (IVC diameter insp), IVC diameter expiration (IVC diameter exp), and inferior vena cava collapsibility index (IVC-CI) were measured at the 0th and 30th minutes of spinal immobilization in both positions. The data were compared for demonstrating the efficiency of both positions in spinal immobilization. Results: A statistically significant difference was found in the parameters of the IVC diameter (exp), IVC diameter (insp), LVOT-VTI, LVSV, and CO through the measurements starting in the 0th minute of the transition from 0° to 20° (P <.001). Delta values (∆) of hemodynamic parameters (∆IVC diameter [exp], ∆IVC diameter [insp], ∆LVOT-VTI, ∆SV, ∆CO, ∆IVC-CI, ∆MAP, ∆SAP, ∆DAP, and ∆HR) were similar in spinal immobilization at 0° and 20°. Conclusion: The findings obtained from this study illustrate that spinal immobilization at 20° does not cause clinically significant hemodynamic changes in healthy subjects compared to spinal immobilization at 0°.

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Fluid administration guided by inferior vena cava ultrasound before spinal anaesthesia may reduce post procedural hypotension rate

10.1101/2021.06.20.21258944 ◽

2021 ◽

Author(s):

Mathieu Favre ◽

Samuele Ceruti ◽

Maira Biggiogero ◽

Michele Musiari ◽

Andrea Glotta ◽

...

Keyword(s):

Inferior Vena Cava ◽

Arterial Pressure ◽

Spinal Anesthesia ◽

Inferior Vena ◽

Reduction Rate ◽

Vena Cava ◽

Clinical Signs ◽

Test Group ◽

Control Group ◽

Group I

PURPOSE: This study was conducted to estimate the incidence of hypotension after spinal anesthesia after inferior vena cava ultrasound (IVCUS) guided volaemic optimization compared with a control group in patients undergoing elective surgery. According to ESICM guidelines, hypotension was defined as two systolic arterial pressure (SAP) measurements < 80 mmHg and / or a mean arterial pressure (MAP) < 60 mmHg, or a drop in SAP of more than 50 mmHg or more than 25% from baseline, or a decrease in MAP by more than 30% from baseline and / or clinical signs/symptoms of inadequate perfusion. MATERIALS AND METHODS: From May 2014 to February 2019, a prospective, controlled, randomised, three-arm, parallel-group trial was performed in our tertiary hospital. In the IVCUS group (I, 132 patients) and passive leg raising test group (L, 148 patients), a pre-anaesthesia volume optimization was achieved following a fluid response protocol. In control group (C, 149 patients), no specific intervention was performed. RESULTS: 474 patients were collected. In group I, hypotension rate was 35%. In group L hypotension rate was 44%. In group C hypotension rate was 46%. An 11% reduction rate in hypotension (95% CI -1 to -24%, P=0.047) was observed between the group I and the group C. A 2% reduction rate in hypotension (95% CI -3 to -5%, P=0.428) was observed between group L and the group C. Total fluid amount administered was greater in the I group I than in the group C (593 ml versus 453 ml, P=0.015) and greater in the group L than the group C (511 ml versus 453 ml, P=0.11). CONCLUSION: IVCUS guided fluid optimization decrease the incidence of arterial hypotension after spinal anesthesia.

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Use of ultrasound for the assessment of dehydration in pediatric patients with mild to moderate dehydration

Emergency Care Journal ◽

10.4081/ecj.2019.8151 ◽

2019 ◽

Vol 15 (2) ◽

Author(s):

Yalda Ravanshad ◽

Anoush Azarfar ◽

Seied Ali Alamdaran ◽

Mitra Naseri ◽

Gholamreza Sarvari ◽

...

Keyword(s):

Inferior Vena Cava ◽

Fluid Therapy ◽

Roc Curve ◽

Inferior Vena ◽

Vena Cava ◽

World Health ◽

Clinical Scale ◽

Oral Rehydration ◽

Significant Difference ◽

Before And After

Management of children with acute gastroenteritis is based upon dehydration estimation. There is no clinical or paraclinical tool which exactly estimates the dehydration degree. Recently ultrasonographic parameters as inferior vena cava (IVC) diameter and aorta (AO) have been used in some studies for this purpose. This study aims to evaluate the efficacy of ultrasound in detecting mild and moderate degrees of dehydration in children. The study was performed in the emergency department of Dr. Sheikh’s Children Hospital, Mashhad, Iran. Children with mild to moderate degrees of dehydration according to World health Organization (WHO) clinical scale were enrolled. Their inferior vena cava diameters, aorta and IVC/AO ratio were measured before and after fluid therapy using ultrasound. Ultrasound was performed by two pediatric sonographers. 36 patients (mean age of 16.94±11.02 months) entered the study. 11 patients had mild and 25 moderate dehydration according to WHO clinical scale. All 11 patients with mild dehydration received oral rehydration. 13 patients in the moderate dehydration group received intravenous rehydration because of oral intolerance to fluids and recurrent vomiting. IVC diameter and IVC/AO ratio after fluid therapy in children with both mild and moderate dehydration degrees was significantly greater (P<0.001). However, we did not observe any significant difference in aorta diameter before and after fluid therapy. Using Receiver Operating Characteristic (ROC) curve, the proper cut-off point of IVC/AO ratio to differentiate patients with moderate dehydration from mild dehydration is equal to 0.782 with sensitivity and specificity equal to 88% and 45.45% respectively. Further, the area under the ROC curve for this cut-off is equal to 0.569. In conclusion, ultrasonography cannot differentiate between mild and moderate dehydration degrees, but studies with larger population of patients should be performed.

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4. Abstract Title: Health Canada Alert Improves Inferior Vena Cava Filter Use: A Before and After Study

Thrombosis Research ◽

10.1016/j.thromres.2018.09.024 ◽

2018 ◽

Vol 170 ◽

pp. 3

Author(s):

Sana Swaleh ◽

Maral Koolian ◽

Blair Carl Schwartz

Keyword(s):

Inferior Vena Cava ◽

Inferior Vena Cava Filter ◽

Inferior Vena ◽

Vena Cava ◽

Vena Cava Filter ◽

Before And After ◽

Health Canada ◽

Before And After Study

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The influence of inferior vena cava compression on the level of spinal anesthesia

American Journal of Obstetrics and Gynecology ◽

10.1016/0002-9378(68)90035-5 ◽

1968 ◽

Vol 101 (6) ◽

pp. 792-800 ◽

Cited By ~ 49

Author(s):

David L. Barclay ◽

O.J. Renegar ◽

Edward W. Nelson

Keyword(s):

Inferior Vena Cava ◽

Spinal Anesthesia ◽

Inferior Vena ◽

Vena Cava

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A Novel Parameter Derived From Photoplethysmographic Pulse Wave to Predict Risk of Postreperfusion Syndrome

10.21203/rs.3.rs-41789/v1 ◽

2020 ◽

Author(s):

Hai-ying Kong ◽

Xian Zhao ◽

Su-Qin Huang

Keyword(s):

Liver Transplantation ◽

Inferior Vena Cava ◽

Inferior Vena ◽

Pulse Wave ◽

Surgical Stress ◽

Vena Cava ◽

Stress Index ◽

Increased Risk ◽

Sympathetic Modulation ◽

Before And After

Abstract BackgroundPostreperfusion syndrome (PRS), observed after reperfusion of the grafted liver, was associated with poor outcome. The end-stage liver disease (ESLD) with autonomic dysfunction in the cardiovascular system has greater risk of developing of PRS, due to the poor ability in sympathetic vasoconstriction. Surgical Stress Index (SSI) is a novel parameter derived from photoplethysmographic pulse wave to assess central sympathetic modulation in awake volunteers. In this study, we determined the relationship between SSI values and the risk of developing of PRS during orthotopic liver transplantation.MethodsWe retrospectively studied 163 patients who had undergone OLT, and divided the patients into PRS group and non-PRS group. SSI and related parameters were determined 5min before and after clamping of the inferior vena cava, the occurrence of PRS were recorded during reperfusion.ResultsThe clamping of the inferior vena cava modified the SSI significantly, accompanied with significant hemodynamic response. The SSI increased significantly after clamping (47.0 (43.0-49.0 ) vs.81.0(69.5-89.0), p<0.001). The SSI increased by 45.3% at 5min after clamping of the inferior vena cava in the PRS group, as opposed to 81.7% in the non-PRS group (P = 0.037). PRS occurred in only 19.4% of patients in whom the SSI increased by more than 50%. Based on a multivariate analysis, percentage of the variation in the SSI was associated with a significant increased risk in developing the PRS (OR 2.49, 95% CI 1.15-5.02; P=0.021).ConclusionsSSI can sensitively indicate the central sympathetic modulation function during liver transplantation procedure. SSI might be a sensitive marker of risk of developing PRS.

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Splanchnic and systemic absorption of intraperitoneal insulin using a new double-tracer method

AJP Endocrinology and Metabolism ◽

10.1152/ajpendo.1994.266.5.e750 ◽

1994 ◽

Vol 266 (5) ◽

pp. E750-E759 ◽

Cited By ~ 2

Author(s):

J. Radziuk ◽

S. Pye ◽

D. E. Seigler ◽

J. S. Skyler ◽

R. Offord ◽

...

Keyword(s):

Inferior Vena Cava ◽

Portal Vein ◽

Inferior Vena ◽

Vena Cava ◽

Systemic Absorption ◽

Tracer Method ◽

Total Recovery ◽

Before And After ◽

Intraperitoneal Insulin ◽

Serial Samples

The absorption of a bolus of intraperitoneal insulin into the splanchnic and peripheral circulations was separately assessed in dogs using an infusion of two insulin tracers (A1-[3H]insulin and B1-[3H]insulin). One tracer was infused into the superior mesenteric artery and the second into the jugular vein. Serial samples were taken before and after an injection of insulin (1 U/kg ip). Sampling was from the portal vein and the inferior vena cava. By using the principle of equivalent entry of tracer and unlabeled material, we developed two simultaneous equations for the rate of splanchnic and peripheral insulin absorption at each time point. These were solved to yield the two rates. Mean concentrations in the portal vein were approximately 25% higher than in the inferior vena cava, reflecting the splanchnic absorption. This rate accounted for almost half (51 +/- 9%) of the insulin absorbed. The remainder of the absorption was peripheral. The total recovery of intraperitoneal insulin, absorbed by either route, was 88 +/- 11%. Portal absorption peaked earlier than peripheral. Absorption by both routes was 90% complete within approximately 2 h (131 +/- 16 min). In summary, therefore, intraperitoneal insulin is rapidly and almost completely absorbed, with absorption split between the splanchnic and peripheral routes of entry.

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Effects of Ambulation and Nondependent Transfers on Vital Signs in Patients Receiving Norepinephrine

American Journal of Critical Care ◽

10.4037/ajcc2017384 ◽

2017 ◽

Vol 26 (1) ◽

pp. 31-36 ◽

Cited By ~ 3

Author(s):

Rosario Arcaya Nievera ◽

Ann Fick ◽

Hilary K. Harris

Keyword(s):

Heart Rate ◽

Mean Arterial Pressure ◽

Physical Therapy ◽

Arterial Pressure ◽

Low Dose ◽

Vital Signs ◽

Activity Level ◽

Significant Difference ◽

Before And After ◽

Norepinephrine Dose

Purpose To assess the safety of mobilizing patients receiving low-dose norepinephrine (0.05 μg/kg per min) by examining mean arterial pressure and heart rate before and after activity with parameters set by the physician. Background Norepinephrine is a peripheral vasoconstrictor administered for acute hypotension. During activity, blood flows to the periphery to supply muscles with oxygen, which may oppose the norepinephrine vasoconstriction. The safety of mobilizing patients receiving norepinephrine is unclear. Methods Heart rate, mean arterial pressure, norepinephrine dose, and activity performed were extracted retrospectively from charts of 47 cardiothoracic surgery patients during the first patient transfer to chair or ambulation with norepinephrine infusing. Mean arterial pressure and heart rate were compared before and after physical therapy (paired t tests). Differences among norepinephrine doses and physical activity levels were evaluated (Kruskal-Wallis test). Results Forty-one of the 47 patients (87%) tolerated the activity within safe ranges of vital signs. The change in patients’ mean arterial pressure from before to after activity was not significant (P = .16), but a significant increase in heart rate occurred after activity (P < .001). A Kruskal-Wallis test showed no significant difference in the norepinephrine dose and activity level (χ2 = 6.34, P = .17). No instances of cardiopulmonary or respiratory arrest occurred during any physical therapy sessions. Conclusions Infusion of low-dose norepinephrine should not be considered an automatic reason to keep patients on bed rest.

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