Echocardiography based algorithm for prevention and treatment of spinal hypotension: a prospective randomised controlled study

Introduction Left ventricular end diastolic area (LVEDA) less than 10 cm2 in mid-papillary para short axis view of transthoracic echocardiogram indicates hypovolemia.1 We compared the efficaciousness of an algorithm based on LVEDA to the standard clinical practice during subarachnoid block (SAB) in the prevention and treatment of post spinal hypotension. Methods After obtaining approval from the institutional ethics committee and written informed consent 60 adults scheduled for elective surgery under SAB were enrolled in this prospective, randomized intention to treat trial. Patients were randomized into two groups. In Group-E (n = 30) echocardiography based algorithm (figure-1) was used to assess LV preload, its optimization before administration of SAB and to decide treatment of post spinal hypotension either with phenylephrine or intravenous fluids. Group-S (n = 30) patients that served as control, received standard management for SAB. The incidence of hypotension, number of episodes of hypotension, magnitude and duration of hypotension, vasopressor requirement, fluid requirement and hemodynamic parameters first 30 minutes after administration of SAB were compared. Results The incidence of hypotension (Gr-E = 26.7% vs Gr-S = 25%, p = 0.766), number of episodes of hypotension (Gr-E 14 vs 12 episodes in Gr-S, p = 0.721), mean duration of hypotension (Gr-E 6.87±3.6 vs 7.42±3.1 minutes in Gr-S, p = 0.757) and magnitude of maximum fall in blood pressure from baseline values(Gr-E 25.9±3.09% vs 27.7±5.68% in Gr-S, p = 0.451) were comparable between the two groups. Total amount of intravenous fluid administered was 2.5 times less in Gr-E (Gr-E = 147.6±119.2 ml vs Gr-S = 390±204 ml, p Discussion Echocardiography based algorithm for the management of spinal hypotension may result in decreased requirement of intravenous fluid and help in optimizing the vasopressor use. However, the incidence of spinal hypotension may remain unchanged.