A PROSPECTIVE OBSERVATIONAL STUDY TO ASSESS CORRELATION OF CAVAL AORTA INDEX WITH CENTRAL VENOUS PRESSURE FOR INTRAVASCULAR VOLUME ASSESSMENT IN PATIENTS UNDERGOING ENDOSCOPIC TRANSURETHERAL RESECTION OF PROSTATE (TURP)

Abstract

INTRODUCTION: There are various techniques for assessing the uid status such as clinical examination, central venous pressure (CVP) measurement, biochemical markers, bio impedance, continuous blood volume measurement, or sonographic inferior vena cava (IVC) diameter assessment. Sonographic evaluation of the IVC and Aorta diameter and its usefulness in evaluating the volume status are studied and documented. The sonographic evaluation of the IVC & Aorta can predict the volume status, this tool can assist anesthetist in rapid diagnosis and prompt resuscitation of patients developing TURP syndrome AIM OF THE STUDY: The aim & objective of this study is to assess the correlation of Caval Aorta index with CVP in intravascular volume assessment in patients undergoing endoscopic Trans Urethral Resection of Prostate (TURP) MATERIALS AND METHODS: The study is carried out in the Department of Anaesthesiology involving Department of Urology in Kanyakumari Government Medical College from January 2018 to June 2019. It is a Prospective observational study. To measure the IVC diameter USG machine probe is placed in the sub-xiphoid region to visualize the conuence of the hepatic veins draining the IVC. The maximum internal AP diameter of the Aorta(Ao) and maximum internal anterior-posterior (AP) diameter of the IVC is measured in the longitudinal plane. Fluid status will be measured by CVP and IVC/Ao index recorded before neuraxial block, after preload, at 5 min after intrathecal block, resection time at 0 min, every 15 min during the rst 30 min, then every 30 min, until the end of surgery. Outcome: Incidence of hypotension after spinal anesthesia in a cesarean section RESULTS: The mean IVC diameter at pre-operative is 15.20±1.42, and at 60 min, 75 min were 19.39±1.92, 20.03±1.76 which suggests that the size and shape of the inferior vena cava (IVC) is correlated to the CVP and circulating blood volume. In my study the mean Aortic diameter at 60 min, 75 min were 20.30±1.01 and 19.81±1.06 which is same as the preoperative level (19.72±1.18) and diameter. The mean CVP at pre-operative is 4.57±0.73, mean CVP at 60 min, 75 min were 7.57±0.82, 8.11±0.78 which denotes that CVP increases as the intravascular volume status increases. In our study mean IVC/Aortic index at pre-operative is 0.77±0.05 and the mean IVC/Aortic index at 15min, 30 min, 60 min, 75 min were 0.87±0.03, 0.90±0.04, 0.95±0.06, 1.01±0.05 which increases signicantly in increasing intravascular volume. The strong correlation between these two variable with Pearson formula ranging from 0.450-0.900. CONCLUSION: As Sonographic caval Ao index is very well correlated with CVP , IVC/Ao index is useful for the evaluation of preoperative and intraoperative volume status, especially in major surgeries with marked uid shift or blood loss and had the advantage of being noninvasive, safe, quick, and easy technique with no complications.