Carotid Ultrasound for Post-Spinal Anesthesia Hypotension in Elderly Hip Surgery

Condition(s) studied

Investigational drug(s) / intervention(s)

Ultrasound: Preoperative point-of-care ultrasonography is performed using a diagnostic ultrasound system (SONY, General Electric (GE) Medical Systems) to evaluate baseline intravascular volume and hemodynamic status before spinal anesthesia. A high-frequency linear ultrasound probe is positioned over the common carotid artery proximal to its bifurcation to record pulsed-wave Doppler waveforms, measuring flow time from systolic upstroke to the dicrotic notch and calculating the corrected carotid flow time (CFTc) using Wodey's formula across three averaged cycles. The ultrasound device is additionally used with a 2-4 megahertz (MHz) transducer to measure the inferior vena cava collapsibility index (IVCCI) via subcostal M-mode imaging during an inspiratory sniff, as well as the left ventricular outflow tract velocity time integral (LVOT-VTI) via apical five-chamber echocardiography, to determine their accuracy in predicting post-spinal anesthesia hypotension.

Study summary

This study aims to evaluate the predictability of preoperative carotid artery-corrected flow time (CFTc) for hypotension after spinal anesthesia in patients undergoing geriatric hip replacement surgery.

Primary outcomes:

• The predictive performance of preoperative CFTc for post-spinal hypotension .

Secondary outcomes:

* Cut-off value, sensitivity, specificity, positive predictive value and negative predictive value of CFTc in prediction of hypotension.
* Cut-off value, sensitivity, specificity, positive predictive value and negative predictive value of IVC collapsibility.
* Cut-off value, sensitivity, specificity, positive predictive value and negative predictive value of echocardiography (ECHO) (LVOT-VTI).
* Comparison of predictive accuracy of CFTc, IVC, and ECHO for post-spinal hypotension.
* Monitoring of systolic blood pressure (SBP), mean arterial pressure (MAP), and heart rate (HR) (first 10 min every 2 minutes, then at 15 min and at 20 min).

Eligibility

Primary outcome measure(s)

• Predictive Performance of Preoperative Corrected Carotid Flow Time (CFTc) for Post-Spinal Hypotension — Preoperative (Baseline, before spinal anesthesia).
  Carotid flow time is measured preoperatively via pulsed-wave Doppler ultrasound of the common carotid artery. A high-frequency linear ultrasound probe is positioned over the common carotid artery proximal to its bifurcation. The flow time is measured from the systolic upstroke to the dicrotic notch and is then corrected for heart rate using Wodey's formula across three averaged cycles.

Trial sites (1)

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