Ultrasound monitoring to detect embolic phenomena in the inferior vena cava during hip arthroplasty
Embolic phenomena frequently occur during hip joint replacement surgery, and may lead to haemodynamic instability in frail patients. Transoesophageal ultrasound monitoring is rarely available in non-cardiac operating theatres, and cannot be performed in awake patients under spinal anaesthesia. The m...
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| Published in: | Revista española de anestesiología y reanimación (English ed.) Vol. 71; no. 7; pp. 506 - 513 |
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| Main Authors: | , , , , , |
| Format: | Journal Article |
| Language: | English |
| Published: |
Spain
Elsevier España, S.L.U
01-08-2024
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| Subjects: | |
| Online Access: | Get full text |
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| Summary: | Embolic phenomena frequently occur during hip joint replacement surgery, and may lead to haemodynamic instability in frail patients. Transoesophageal ultrasound monitoring is rarely available in non-cardiac operating theatres, and cannot be performed in awake patients under spinal anaesthesia. The main objectives of this prospective exploratory study were to determine the feasibility of using an alternative ultrasound approach to monitor the inferior vena cava during hip replacement surgery, and to determine the intra and interobserver reliability of the ultrasound findings.
We conducted a prospective exploratory study in 20 patients undergoing cemented hip arthroplasty in the supine position under spinal anaesthesia and sedation. The inferior vena cava was assessed through a subcostal window at 10 intraoperative time points, and the findings were rated on a qualitative embolism severity scale. The ultrasound images were evaluated by 2 independent observers.
An adequate subcostal window was obtained in 90% of cases. Intra- and inter-observer reliability was high (kappa index >0.80, p < 0.001). Nearly all (95%) patients presented some degree of embolism, which was severe in 50% of cases.
Our study suggests that ultrasound assessment of embolic phenomena in the inferior vena cava through a subcostal window is feasible in 90% of cases. The qualitative embolic severity rating scale is highly reproducible and has high intra- and inter-observer reliability.
Los fenómenos embólicos son frecuentes en los reemplazos articulares de cadera, pudiendo llevar a compromiso hemodinámico en pacientes frágiles. La monitorización sonográfica con ecografía transesofágica no está normalmente disponible en las salas operatorias no-cardiacas y no es aplicable al paciente despierto bajo anestesia raquídea. Los objetivos principales de este estudio prospectivo exploratorio son determinar la factibilidad del monitoreo sonográfico alternativo de la Vena Cava Inferior durante la cirugía de reemplazo de cadera y estudiar la fiabilidad intra e interobservador del examen.
Realizamos un estudio prospectivo exploratorio donde se incluyeron 20 pacientes sometidos a artroplastia de cadera cementada en decúbito supino bajo anestesia raquídea y sedación a los cuales se les realizó una valoración intraoperatoria de la vena cava inferior a través de una ventana subcostal durante 10 diferentes momentos quirúrgicos aplicando una escala cualitativa de severidad de embolia. Las imágenes de cada caso fueron evaluadas por dos observadores independientes.
Una ventana subcostal adecuada se pudo obtener y monitorizar en el 90% de los casos. La variabilidad intra e inter observador presentó un alto índice de fiabilidad (índice kappa >0.80, p < 0,001). El 95% de los pacientes presentó algún grado de embolia, siendo severa en el 50% de estos.
Nuestro estudio sugiere que el monitoreo sonográfico de la Vena Cava Inferior a través de una ventana subcostal es factible para la evaluación de fenómenos embólicos durante reemplazos articulares de cadera en el 90% de los casos. La escala de valoración cualitativa de severidad de embolia es altamente reproducible con una alta fiabilidad intra e inter observador. |
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| Bibliography: | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 |
| ISSN: | 2341-1929 2341-1929 |
| DOI: | 10.1016/j.redare.2024.04.017 |