Evaluation of Changes of Venous Return After Spinal and Epidural Analgesia and Anesthesia by Ultrasound Guided Vena Cava Diameter Measurement
| Status: | Recruiting |
|---|---|
| Conditions: | Cardiology, Cardiology, Women's Studies |
| Therapuetic Areas: | Cardiology / Vascular Diseases, Reproductive |
| Healthy: | No |
| Age Range: | 18 - Any |
| Updated: | 1/3/2019 |
| Start Date: | May 18, 2018 |
| End Date: | June 15, 2019 |
| Contact: | Efrain Riveros Perez, MD |
| Email: | eriverosperez@augusta.edu |
| Phone: | 7067217361 |
The investigators propose this study to test the hypotheses that inferior vena cava (IVC)
diameter can predict hypotension after labor analgesia (epidural, combined spinal-epidural)
and neuraxial anesthesia for cesarean section (epidural, combined spinal-epidural and spinal
block) in full-term pregnant patients.
diameter can predict hypotension after labor analgesia (epidural, combined spinal-epidural)
and neuraxial anesthesia for cesarean section (epidural, combined spinal-epidural and spinal
block) in full-term pregnant patients.
After approval by the Institutional Review Board and patient consent, term pregnant patients
(>37 week gestation) admitted to the obstetric service of Augusta University Medical Center,
who require administration of neuraxial analgesia for labor or regional anesthesia for
cesarean section, will be included in the study. The consent will be obtained by the
attending, resident or medical student in which the investigators will explain to the patient
the procedure, benefit, risk, cost and, confidentiality. The investigators plan to get the
consent immediately after the patient arrived at the unit to avoid any interference with the
delivery process. If the patient needs to go to an emergency cesarean section. This patient
is not going to be included in the study. Demographic variables (age, BMI, Gravity, parity
and gestation weeks) and hemodynamic variables (MAP and HR) will be recorded. All patients
will be lying in supine position, breathing spontaneously. The ultrasound examination will be
performed before commencement of the neuraxial procedure and will be repeated two minutes
after administration of the neuraxial anesthetic. Ultrasound measurements will be made with a
Sonosite Edge (Sonosite Inc. USA) machine and a C60X curved linear phased array transducer
(Sonosite Inc.) set to abdominal mode. All measurements will be made by two attending
anesthesiologists (ERP and AR) who have experience in transthoracic echocardiography, and a
resident who receives the basic instruction to measure IVC diameter. The medical student will
be present during the procedure and will ensure that the study echocardiographic views are
taken.
The IVC will be visualized using a paramedian long-axis view via a subcostal approach
according to guidelines of the American Society of Echocardiography. A two-dimensional image
of the IVC will be obtained and pulsed wave Doppler will be used to differentiate from the
aorta. Variations in IVC diameters will be assessed with M-mode applied 2 cm. distal to the
right atrium. To ensure consistent measurements, each operator will take three images. The
best quality images are chosen. Maximum and minimum IVC diameters during a single respiratory
cycle will be measured.
(>37 week gestation) admitted to the obstetric service of Augusta University Medical Center,
who require administration of neuraxial analgesia for labor or regional anesthesia for
cesarean section, will be included in the study. The consent will be obtained by the
attending, resident or medical student in which the investigators will explain to the patient
the procedure, benefit, risk, cost and, confidentiality. The investigators plan to get the
consent immediately after the patient arrived at the unit to avoid any interference with the
delivery process. If the patient needs to go to an emergency cesarean section. This patient
is not going to be included in the study. Demographic variables (age, BMI, Gravity, parity
and gestation weeks) and hemodynamic variables (MAP and HR) will be recorded. All patients
will be lying in supine position, breathing spontaneously. The ultrasound examination will be
performed before commencement of the neuraxial procedure and will be repeated two minutes
after administration of the neuraxial anesthetic. Ultrasound measurements will be made with a
Sonosite Edge (Sonosite Inc. USA) machine and a C60X curved linear phased array transducer
(Sonosite Inc.) set to abdominal mode. All measurements will be made by two attending
anesthesiologists (ERP and AR) who have experience in transthoracic echocardiography, and a
resident who receives the basic instruction to measure IVC diameter. The medical student will
be present during the procedure and will ensure that the study echocardiographic views are
taken.
The IVC will be visualized using a paramedian long-axis view via a subcostal approach
according to guidelines of the American Society of Echocardiography. A two-dimensional image
of the IVC will be obtained and pulsed wave Doppler will be used to differentiate from the
aorta. Variations in IVC diameters will be assessed with M-mode applied 2 cm. distal to the
right atrium. To ensure consistent measurements, each operator will take three images. The
best quality images are chosen. Maximum and minimum IVC diameters during a single respiratory
cycle will be measured.
Inclusion Criteria:
1. Pregnant patients >37 weeks of gestation
2. Indication for neuraxial labor analgesia or regional anesthesia for cesarean section
3. Age older than 18 years
4. Pregnancy without diagnosed comorbidities
Exclusion criteria:
1. Unwillingness to participate in the study
2. Diagnosis of Hypertensive disorders of pregnancy
3. Diagnosis of cardiopulmonary disease
4. Allergy to US gel
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