Non-invasive haemodynamic monitoring with Clearsight in patients undergoing spinal anaesthesia for total hip replacement. A prospective observational cohort study.: Clearsight monitoring for spinal block

Daniela Ghisi; Marco Garroni; Sandra Giannone; Giovanni De Grandis; Andrea Fanelli; Maria Cristina Sorella; Stefano Bonarelli; Rita Maria Melotti

doi:10.23750/abm.v91i4.8665

Non-invasive haemodynamic monitoring with Clearsight in patients undergoing spinal anaesthesia for total hip replacement. A prospective observational cohort study.

Clearsight monitoring for spinal block

Authors

Daniela Ghisi Department of Anesthesia and Psotoperative Intensive Care, Istituto Ortopedico Rizzoli, Bologna
Marco Garroni b. Anesthesia and Intensive Care, Ospedale Santa Maria delle Croci, viale Randi 5, 48121 Ravenna, Italy
Sandra Giannone c. Anesthesia, Intensive Care and Pain Therapy, Istituto Ortopedico Rizzoli, via G.C. Pupilli 1, 40136 Bologna, Italy
Giovanni De Grandis d. Anesthesia, Intensive Care and Pain Therapy, Istituto Ortopedico Rizzoli, via G.C. Pupilli 1, 40136 Bologna, Italy
Andrea Fanelli e. Anesthesia and Pain Therapy, Policlinico Sant’Orsola-Malpighi, via Albertoni 15, 40138 Bologna, Italy
Maria Cristina Sorella f. Department of Medicine and Surgical Sciences, Universita’ degli Studi di Bologna, via Massarenti 9, 40138 Bologna, Italy
Stefano Bonarelli g. Anesthesia, Intensive Care and Pain Therapy, Istituto Ortopedico Rizzoli, via G.C. Pupilli 1, 40136 Bologna, Italy
Rita Maria Melotti h. Department of Medicine and Surgical Sciences, Universita’ degli Studi di Bologna, via Massarenti 9, 40138 Bologna, Italy

DOI: https://doi.org/10.23750/abm.v91i4.8665

Keywords:

hemodynamic; monitoring, intraoperative; anesthesia, spinal; arthroplasty, replacement, hip.

Abstract

Background: Patients undergoing elective primary total hip replacement and spinal anesthesia may encounter significant hemodynamic instability

Objective: The study is aimed at observing the haemodynamic modifications after spinal anaesthesia during total hip replacement in patients managed to "preload independence" with goal directed fluid therapy (GDFT) and monitored non-invasively with Clearsight.

Methods: Thirty patients, aged 50-80 years, with an American Society of Anaesthesiologists' (ASA) score II-III, undergoing elective primary total hip replacement and spinal anaesthesia were enrolled. Patients were monitored with the EV1000 platform and the Clearsight finger-cuff and managed with a goal directed fluid therapy.

Results: The 79% of the population showed preload independence at baseline. After spinal, the 93% did not show a significant mean arterial pressure reduction. In our population, 79% reported a decrease >10% of the stroke volume during surgery, while 66% in the Recovery Room. Patients showed an improvement in mean arterial pressure, systemic vascular resistances indexed (SVRI), stroke volume (SV) and stroke volume indexed (SVI) at spinal resolution compared to baseline.

Conclusions: Our cohort population showed hemodynamic stability throughout the study period, with increased SV and decreased SVRI at spinal resolution compared to basal values. Further randomized prospective studies are advocated in the same setting.