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Effectiveness of Using Ultrasound-Inferior Venacava Collapsibility Index (IVCCI) as a Guidance Tool for Resuscitating the Patients Undergoing Emergency Lower Limb Orthopaedic Surgeries Under Spinal Anaesthesia

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Vol 5 | Issue 1 | January-June 2024 | Page 24-29| S. Narmatha Yangste, S. Shankar Raju, Bhaskar

DOI: https://doi.org/10.13107/ijra.2024.v05.i01.087

Authors: S. Narmatha Yangste [1], S. Shankar Raju [2], Bhaskar [3]

[1] Department of Anesthesiology, Coimbatore Medical College and Hospital, Coimbatore, Tamil Nadu, India.
[2] Department of Anesthesiology, ESI medical college, Coimbatore, Tamil Nadu, India.
[3] Department of Anesthesiology, Dharmapuri Medical College, Dharmapuri, Tamil Nadu, India.

Address of Correspondence
Dr. S. Narmatha Yangste,
Associate Professor, Department of Anesthesiology, Coimbatore Medical College and Hospital, Coimbatore, Tamil Nadu, India.
E-mail: nyangtse75@gmail.com

Abstract

Background and Aim: Ultrasound-guided inferior vena cava collapsibility index (IVCCI) is used for assessing the volume status of the patient in critical care but for emergency cases taken up under spinal anesthesia this index helps to assess the adequacy of resuscitation. In our study, we aimed to evaluate the usefulness of ultrasound in adequately resuscitating patients requiring subarachnoid block for emergency lower limb orthopedic surgeries.
Methods: After obtaining approval from the Coimbatore Medical College institutional ethical committee, 60 adults aged between 20 and 60 comprising both sexes requiring emergency lower limb [shaft of femur] orthopedics surgeries were included in this randomized clinical study. After a complete pre-anaesthetic assessment, IVCCI by ultrasound is measured. The patient was resuscitated to a target IVCCI of ≤30% before performing the subarachnoid block from the USG group. The other group of patients was resuscitated till the mean arterial pressure (MAP) was≥65 mm Hg from the MAP group. Then spinal anaesthesia was performed in a sitting position via L3 – L4 interspace using a 25 G Quincke’s needle. The parameters were monitored every 5 minutes for 30 minutes post-spinal.
Results: The incidence and severity of hypotension are lesser in the ultrasound group compared to the MAP group which was statistically significant (p=0.004).
Conclusion: Our study concludes that the USG-guided fluid resuscitation with a target IVCCI ≤30% for emergency surgeries under spinal anaesthesia does reduce the severity of hypotension and its adverse outcomes.
Keywords: Inferior vena cava, Lower limb, Fracture, Mean arterial pressure, Ultrasound, Spinal anesthesia

References

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How to Cite this Article: Raju SS, Yangste SN, Kalyanasundaram K | Effectiveness of Using Ultrasound-Inferior Venacava Collapsibility Index (IVCCI) as a Guidance Tool for Resuscitating the Patients Undergoing Emergency Lower Limb Orthopaedic Surgeries Under Spinal Anaesthesia | International Journal of Regional Anaesthesia | January-June 2024; 5(1): 24-29 | DOI: https://doi.org/10.13107/ijra.2024.v05.i01.87

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Pendant Positioning Vs Traditional Sitting for Successful Spinal Punctures in Elderly

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Vol 4 | Issue 2 | July-December 2023 | Page 9-13 | Tamasi Dawn, Yatindra Kumar Batra, Sunny Rupal, Komal Jit Kaur, Tanvir Samra

DOI: https://doi.org/10.13107/ijra.2023.v04i02.076

Submitted: 10-08-2023; Reviewed: 06-09-2023; Accepted: 24-10-2023; Published: 10-12-2023

Authors: Tamasi Dawn [1], Yatindra Kumar Batra [1], Sunny Rupal [1], Komal Jit Kaur [1], Tanvir Samra [2]

[1] Department of Anaethesiology Max superspeciality Hospital, Mohali, Punjab, India.
[2] Department of Anaesthesia PGIMER, Chandigarh, India.

Address of Correspondence
Dr. Tanvir Samra,
Associate Professor Department of Anaesthesia PGIMER, Chandigarh, India.
E-mail: drtanvirsamra@yahoo.co.in

Abstract

Background- The ability of the pendant position in increasing the intervertebral spaces translating in an increase in the 1st attempt spinal puncture success rate has been reported in pregnant females undergoing cesarean section. However, the same has not been done for the elderly patients in which age-related degenerative anatomical changes, decreased lordosis, disseminated sclerosis, and extensive osteophytosis is known to reduce the intervertebral space.
Materials and Methods- A prospective randomized controlled study was conducted in patients aged 60-80 years undergoing urological surgeries after approvalfrom the Institutional Ethics Committee and written informed consent from the patients. Primary aim was to compare the number of bone contacts during administration of subarachnoid block with the patient in either pendant (Group A) or traditional (Group B) position. Secondary aims were to compare the proportion of successful spinal needle placements, ease of palpation of spinous processes, patient’s comfort, number of spaces used, time to perform spinal puncture, time to reach grade III (as per modified bromage score) motor blockade, time to reach T10 sensory level and rate of complications in both the groups.
Results- Demographic data was comparable and there was no statistical difference in number of bone contacts, ease of administration, success of spinal needle placements, performance times of subarachnoid block and duration of spinal anaesthesia in both the groups. Complication rates were comparable.
Conclusion- Pendant positioning does not confer any advantage over the traditional sitting position in success rates and performance characteristics of subarachnoid block in elderly (60-80 years) patients scheduled for urological surgeries.
Keywords: Pendant position, Spinal-bone contact, Spinal Needle Puncture, Lumbar puncture, Spinal anesthesia, Aged

References

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How to Cite this Article:  Dawn T, Batra YK, Rupal S, Kaur KJ, Samra T | Pendant Positioning Vs Traditional Sitting for Successful Spinal Punctures in Elderly | International Journal of Regional Anaesthesia | July- December 2023; 4(2): 9-13 | DOI: https://doi.org/10.13107/ijra.2023.v04i02.076

(Abstract Text HTML)    (Download PDF)