Comparison of haemodynamic parameters between the high and low spinal block in young healthy patients

Background. For some surgical proce-dures a higher sensory block is needed. However, it is complicated by a higher in-cidence of hypotension, more bradycardia and nausea and a higher use of vasoactive drugs. In elderly and obstetric population complications have been attributed to the decrease in cardiac output and systemic vascular resistance, especially in a high block (above Th6). The aim of our study was to find the incidence of hypotension and bradycardia after a spinal anaesthesia in young, healthy patients. As young pa-tients compensate more, we aimed to find the difference in haemodynamic variables between the group with a high and the group with a low spinal block and the un-derlying mechanisms of hypotension. Methods. In a prospective, randomized study 44 American Society of Anaesthe-siologists (ASA) 1 patients scheduled for knee arthroscopy under spinal anaesthe-sia were randomly distributed to a high (group H) and a low (group L) spinal block group. In a group H patients were placed into horizontal, whereas in a group L in 15-degree anti-Trendelenburg posi-tion immediately after the spinal block. Haemodynamic parameters were meas-ured continuously noninvasively from 10 min before to 25 min after the spinal block using the CNAPTM device with the LiD-CORapid monitor.

Results. The differences in haemodynamic parameters between the groups were not statistically significant at all measured times despite a significant difference in the spinal block level (18.5 vs 13.3 dermato-mes above S5, p<0.001) and a significant difference in haemodynamic variables inside each group compared to the base-line value. With cardiac index (CI) as a dependent variable, a significant correla-tion between CI and stroke volume in-dex (SVI) was found (β=0.849, p<0.001) and also between CI and heart rate (HR) (β=0.573, p<0.001). In group H the inci-dence of hypotension was 35%, whereas in group L it was 10%. The same difference was seen in the use of phenylephrine be-tween the groups, however the difference was not significant.

Conclusion. In our study it was found that in young, healthy patients there are no significant differences in haemodynamic parameters and in incidence of hypoten-sion between a high and low spinal block. Young, healthy patients compensate a decrease in systemic vascular resistance caused by the spinal anaesthesia with a compensatory increase in CI resulting from an increase in SVI and HR. How-ever, a trend towards less hypotension, less bradycardia and less frequent phenyle-phrine use in a low spinal block was noted.

spinal anaesthesia, hyperbaric bupivacaine, haemodynamic parameters, cardiac output, hypotension

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