Title
Author
DOI
Article Type
Special Issue
Volume
Issue
Comparison of haemodynamic parameters between the high and low spinal block in young healthy patients
1Department of Anaesthesiology and Intensive Care, University Medical Centre Ljubljana
*Corresponding Author(s): PETER POREDOS E-mail: peter.poredos@kclj.si
Background: For some surgical procedures a higher sensory block is needed. How-ever, it is complicated by a higher inci-dence 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 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
PETER POREDOS,VESNA NOVAK-JANKOVIC. Comparison of haemodynamic parameters between the high and low spinal block in young healthy patients. Signa Vitae. 2017. 13(S1);32-43.
1. Carpenter RL, Caplan RA, Brown DL, Stephenson C, Wu R. Incidence and risk factors for side effects of spinal anesthesia. Anesthe-siology. 1992;76(6):906-16.
2. Critchley LA, Stuart JC, Short TG, Gin T. Haemodynamic effects of subarachnoid block in elderly patients. British journal of anaes-thesia. 1994;73(4):464-70.
3. Coe AJ, Revanas B. Is crystalloid preloading useful in spinal anaesthesia in the elderly? Anaesthesia. 1990;45(3):241-3.
4. Tarkkila PJ, Kaukinen S. Complications during spinal anesthesia: a prospective study. Regional anesthesia. 1991;16(2):101-6.
5. McCrae AF, Wildsmith JA. Prevention and treatment of hypotension during central neural block. British journal of anaesthesia. 1993;70(6):672-80.
6. Sprung J, Warner ME, Contreras MG, Schroeder DR, Beighley CM, Wilson GA, et al. Predictors of survival following cardiac arrest in patients undergoing noncardiac surgery: a study of 518,294 patients at a tertiary referral center. Anesthesiology. 2003;99(2):259-69.
7. Monk TG, Saini V, Weldon BC, Sigl JC. Anesthetic management and one-year mortality after noncardiac surgery. Anesthesia and analgesia. 2005;100(1):4-10.
8. Talakoub R, Fani A, Hirmanpour A. Comparison of the effects of colloid preload, vasopressor administration and leg compression on hemodynamic changes during spinal anesthesia for lumbar disc surgery in knee-chest position. Advanced biomedical research. 2015;4:181.
9. Cook PR, Malmqvist LA, Bengtsson M, Tryggvason B, Lofstrom JB. Vagal and sympathetic activity during spinal analgesia. Acta anaesthesiologica Scandinavica. 1990;34(4):271-5.
10. Riley ET. Editorial I: Spinal anaesthesia for Caesarean delivery: keep the pressure up and don’t spare the vasoconstrictors. British journal of anaesthesia. 2004;92(4):459-61.
11. Azzolina R CG, Navarria D, Chiarenza F, Fiorino LS, Francesco AD, et al. Current guldelines for the prevention of hypotension in-duced by spinal anesthesia. . Acta Medica Mediterranea. 2011;27:107.
12. Hirose M, Chun TY, Tobita M, Muramatsu K, Hara Y. The influence of aging on skin temperature and hemodynamic changes during spinal anesthesia. Acta anaesthesiologica Scandinavica. 1995;39(7):891-5.
13. Zorko N, Kamenik M, Starc V. The effect of Trendelenburg position, lactated Ringer’s solution and 6% hydroxyethyl starch solution on cardiac output after spinal anesthesia. Anesth Analg. 2009;108(2):655-9.
14. Rooke GA, Freund PR, Jacobson AF. Hemodynamic response and change in organ blood volume during spinal anesthesia in elderly men with cardiac disease. Anesth Analg. 1997;85(1):99-105.
15. Arndt JO, Hock A, Stanton-Hicks M, Stuhmeier KD. Peridural anesthesia and the distribution of blood in supine humans. Anesthe-siology. 1985;63(6):616-23.
16. Ledowski T, Paech MJ, Browning R, Preuss J, Schug SA. An observational study of skin conductance monitoring as a means of pre-dicting hypotension from spinal anaesthesia for caesarean delivery. International journal of obstetric anesthesia. 2010;19(3):282-6.
17. Hanss R, Ohnesorge H, Kaufmann M, Gaupp R, Ledowski T, Steinfath M, et al. Changes in heart rate variability may reflect sympa-tholysis during spinal anaesthesia. Acta anaesthesiologica Scandinavica. 2007;51(10):1297-304.
18. Dyer RA, Reed AR, van Dyk D, Arcache MJ, Hodges O, Lombard CJ, et al. Hemodynamic effects of ephedrine, phenylephrine, and the coadministration of phenylephrine with oxytocin during spinal anesthesia for elective cesarean delivery. Anesthesiology.2009;111(4):753-65.
19. Asehnoune K, Larousse E, Tadie JM, Minville V, Droupy S, Benhamou D. Small-dose bupivacaine-sufentanil prevents cardiac output modifications after spinal anesthesia. Anesthesia and analgesia. 2005;101(5):1512-5.
20. Langesaeter E, Rosseland LA, Stubhaug A. Continuous invasive blood pressure and cardiac output monitoring during cesarean de-livery: a randomized, double-blind comparison of low-dose versus high-dose spinal anesthesia with intravenous phenylephrine or placebo infusion. Anesthesiology. 2008;109(5):856-63.
21. Glaser C, Marhofer P, Zimpfer G, Heinz MT, Sitzwohl C, Kapral S, et al. Levobupivacaine versus racemic bupivacaine for spinal an-esthesia. Anesthesia and analgesia. 2002;94(1):194-8, table of contents.
22. Minville V, Asehnoune K, Delussy A, Fourcade O, Colombani A, Rabinowitz A, et al. Hypotension during surgery for femoral neck fracture in elderly patients: effect of anaesthetic techniques. A retrospective study. Minerva anestesiologica. 2008;74(12):691-6.
23. Mueller RP, Lynn RB, Sancetta SM, Heckman C, Janouskovec H. Studies of hemodynamic changes in humans following induction of low and high spinal anesthesia. II. The changes in splanchnic blood flow, oxygen extraction and consumption, and splanchnic vascular resistance in humans not undergoing surgery. Circulation. 1952;6(6):894-901.
24. Mark JB, Steele SM. Cardiovascular effects of spinal anesthesia. International anesthesiology clinics. 1989;27(1):31-9.
25. Hamel MB, Henderson WG, Khuri SF, Daley J. Surgical outcomes for patients aged 80 and older: morbidity and mortality from major noncardiac surgery. Journal of the American Geriatrics Society. 2005;53(3):424-9.
26. Nakasuji M, Suh SH, Nomura M, Nakamura M, Imanaka N, Tanaka M, et al. Hypotension from spinal anesthesia in patients aged greater than 80 years is due to a decrease in systemic vascular resistance. Journal of clinical anesthesia. 2012;24(3):201-6.
27. Clapp JF, 3rd, Capeless E. Cardiovascular function before, during, and after the first and subsequent pregnancies. The American journal of cardiology. 1997;80(11):1469-73.
28. Sakai K, Imaizumi T, Maeda H, Nagata H, Tsukimori K, Takeshita A, et al. Venous distensibility during pregnancy. Comparisons between normal pregnancy and preeclampsia. Hypertension. 1994;24(4):461-6.
29. Ngan Kee WD. Prevention of maternal hypotension after regional anaesthesia for caesarean section. Current opinion in anaesthesiol-ogy. 2010;23(3):304-9.
30. Hanss R IC, Missalla H, Steinfath M, Bein B. Continuous noninvasive blood pressure monitoring during spinal anesthesia for cesar-ean delivery. European Journal of Anaesthesiology 2010;27:166-7.
31. Chamos C, Vele L, Hamilton M, Cecconi M. Less invasive methods of advanced hemodynamic monitoring: principles, devices, and their role in the perioperative hemodynamic optimization. Perioperative medicine. 2013;2(1):19.
32. Minville V, Asehnoune K, Salau S, Bourdet B, Tissot B, Lubrano V, et al. The effects of spinal anesthesia on cerebral blood flow in the very elderly. Anesth Analg. 2009;108(4):1291-4.
33. Obasuyi BI, Fyneface-Ogan S, Mato CN. A comparison of the haemodynamic effects of lateral and sitting positions during induction of spinal anaesthesia for caesarean section. Int J Obstet Anesth. 2013;22(2):124-8.
34. Klohr S, Roth R, Hofmann T, Rossaint R, Heesen M. Definitions of hypotension after spinal anaesthesia for caesarean section: litera-ture search and application to parturients. Acta Anaesthesiol Scand. 2010;54(8):909-21.
35. Wakeling HG, McFall MR, Jenkins CS, Woods WG, Miles WF, Barclay GR, et al. Intraoperative oesophageal Doppler guided fluid management shortens postoperative hospital stay after major bowel surgery. British journal of anaesthesia. 2005;95(5):634-42.
36. Stoneham MD, Eldridge J, Popat M, Russell R. Oxford positioning technique improves haemodynamic stability and predictability of block height of spinal anaesthesia for elective caesarean section. Int J Obstet Anesth. 1999;8(4):242-8.
37. El-Hakeem EE, Kaki AM, Almazrooa AA, Al-Mansouri NM, Alhashemi JA. Effects of sitting up for five minutes versus immediately lying down after spinal anesthesia for Cesarean delivery on fluid and ephedrine requirement; a randomized trial. Can J Anaesth. 2011;58(12):1083-9.
38. Kim JT, Shim JK, Kim SH, Jung CW, Bahk JH. Trendelenburg position with hip flexion as a rescue strategy to increase spinal anaes-thetic level after spinal block. Br J Anaesth. 2007;98(3):396-400.
39. Racle JP, Benkhadra A, Poy JY, Gleizal B. Spinal analgesia with hyperbaric bupivacaine: influence of age. Br J Anaesth. 1988;60(5):508-14.
40. Veering BT, Burm AG, Vletter AA, van den Hoeven RA, Spierdijk J. The effect of age on systemic absorption and systemic disposition of bupivacaine after subarachnoid administration. Anesthesiology. 1991;74(2):250-7.
41. Vercauteren MP, Coppejans HC, Hoffmann VL, Saldien V, Adriaensen HA. Small-dose hyperbaric versus plain bupivacaine during spinal anesthesia for cesarean section. Anesth Analg. 1998;86(5):989-93.
42. Fan SZ, Susetio L, Wang YP, Cheng YJ, Liu CC. Low dose of intrathecal hyperbaric bupivacaine combined with epidural lidocaine for cesarean section--a balance block technique. Anesth Analg. 1994;78(3):474-7.
43. Van de Velde M, Van Schoubroeck D, Jani J, Teunkens A, Missant C, Deprest J. Combined spinal-epidural anesthesia for cesarean delivery: dose-dependent effects of hyperbaric bupivacaine on maternal hemodynamics. Anesth Analg. 2006;103(1):187-90, table of contents.
44. Ben-David B, Miller G, Gavriel R, Gurevitch A. Low-dose bupivacaine-fentanyl spinal anesthesia for cesarean delivery. Reg Anesth Pain Med. 2000;25(3):235-9.
45. Wood RJ, White SM. Anaesthesia for 1131 patients undergoing proximal femoral fracture repair: a retrospective, observational study of effects on blood pressure, fluid administration and perioperative anaemia. Anaesthesia. 2011;66(11):1017-22.
46. Cesur M, Alici HA, Erdem AF, Borekci B, Silbir F. Spinal anesthesia with sequential administration of plain and hyperbaric bupiv-acaine provides satisfactory analgesia with hemodynamic stability in cesarean section. Int J Obstet Anesth. 2008;17(3):217-22.
47. McNaught AF, Stocks GM. Epidural volume extension and low-dose sequential combined spinal-epidural blockade: two ways to reduce spinal dose requirement for caesarean section. Int J Obstet Anesth. 2007;16(4):346-53.
48. Martyr JW, Stannard KJ, Gillespie G. Spinal-induced hypotension in elderly patients with hip fracture. A comparison of glucose-free bupivacaine with glucose-free bupivacaine and fentanyl. Anaesth Intensive Care. 2005;33(1):64-8.
49. Veering BT, Ter Riet PM, Burm AG, Stienstra R, Van Kleef JW. Spinal anaesthesia with 0.5% hyperbaric bupivacaine in elderly pa-tients: effect of site of injection on spread of analgesia. Br J Anaesth. 1996;77(3):343-6.
50. Kim JT, Lee JH, Cho CW, Kim HC, Bahk JH. The influence of spinal flexion in the lateral decubitus position on the unilaterality of spinal anesthesia. Anesth Analg. 2013;117(4):1017-21.
51. Borodiciene J, Gudaityte J, Macas A. Lithotomy versus jack-knife position on haemodynamic parameters assessed by impedance car-diography during anorectal surgery under low dose spinal anaesthesia: a randomized controlled trial. BMC Anesthesiol. 2015;15:74.
52. Lawicka M, Malek A, Antczak D, Wajlonis A, Owczuk R. Non-invasive haemodynamic measurements with Nexfin predict the risk of hypotension following spinal anaesthesia. Anaesthesiol Intensive Ther. 2015;47(4):303-8.
53. Banerjee A, Stocche RM, Angle P, Halpern SH. Preload or coload for spinal anesthesia for elective Cesarean delivery: a meta-analysis. Can J Anaesth. 2010;57(1):24-31.
54. Madi-Jebara S, Ghosn A, Sleilaty G, Richa F, Cherfane A, Haddad F, et al. Prevention of hypotension after spinal anesthesia for cesar-ean section: 6% hydroxyethyl starch 130/0.4 (Voluven) versus lactated Ringer’s solution. J Med Liban. 2008;56(4):203-7.
55. Owczuk R, Wenski W, Polak-Krzeminska A, Twardowski P, Arszulowicz R, Dylczyk-Sommer A, et al. Ondansetron given intrave-nously attenuates arterial blood pressure drop due to spinal anesthesia: a double-blind, placebo-controlled study. Reg Anesth Pain Med. 2008;33(4):332-9.
56. Liu Y, Pian-Smith MC, Leffert LR, Minehart RD, Torri A, Cote C, et al. Continuous measurement of cardiac output with the electrical velocimetry method in patients under spinal anesthesia for cesarean delivery. J Clin Monit Comput. 2015;29(5):627-34.
57. Lesser JB, Sanborn KV, Valskys R, Kuroda M. Severe bradycardia during spinal and epidural anesthesia recorded by an anesthesia information management system. Anesthesiology. 2003;99(4):859-66.
58. Veeser M, Hofmann T, Roth R, Klohr S, Rossaint R, Heesen M. Vasopressors for the management of hypotension after spinal anes-thesia for elective caesarean section. Systematic review and cumulative meta-analysis. Acta Anaesthesiol Scand. 2012;56(7):810-6.
59. Doherty A, Ohashi Y, Downey K, Carvalho JC. Phenylephrine infusion versus bolus regimens during cesarean delivery under spinal anesthesia: a double-blind randomized clinical trial to assess hemodynamic changes. Anesth Analg. 2012;115(6):1343-50.
60. Ngan Kee WD, Lee A, Khaw KS, Ng FF, Karmakar MK, Gin T. A randomized double-blinded comparison of phenylephrine and ephedrine infusion combinations to maintain blood pressure during spinal anesthesia for cesarean delivery: the effects on fetal acid-base status and hemodynamic control. Anesth Analg. 2008;107(4):1295-302.
61. Lee A, Ngan Kee WD, Gin T. A quantitative, systematic review of randomized controlled trials of ephedrine versus phenylephrine for the management of hypotension during spinal anesthesia for cesarean delivery. Anesth Analg. 2002;94(4):920-6, table of contents.
62. Clark DI, Ahmed AB, Baxendale BR, Moran CG. Cardiac output during hemiarthroplasty of the hip. A prospective, controlled trial of cemented and uncemented prostheses. J Bone Joint Surg Br. 2001;83(3):414-8.
63. Ilies C, Kiskalt H, Siedenhans D, Meybohm P, Steinfath M, Bein B, et al. Detection of hypotension during Caesarean section with continuous non-invasive arterial pressure device or intermittent oscillometric arterial pressure measurement. Br J Anaesth. 2012;109(3):413-9.
64. Jeleazcov C, Krajinovic L, Munster T, Birkholz T, Fried R, Schuttler J, et al. Precision and accuracy of a new device (CNAPTM) for continuous non-invasive arterial pressure monitoring: assessment during general anaesthesia. Br J Anaesth. 2010;105(3):264-72.
65. El-Hamamsy I, Durrleman N, Stevens LM, Leung TK, Theoret S, Carrier M, et al. Incidence and outcome of radial artery infections following cardiac surgery. Ann Thorac Surg. 2003;76(3):801-4.
66. Xiao W, Duan QF, Fu WY, Chi XZ, Wang FY, Ma DQ, et al. Goal-directed Fluid Therapy May Improve Hemodynamic Stability of Parturient with Hypertensive Disorders of Pregnancy Under Combined Spinal Epidural Anesthesia for Cesarean Delivery and the Well-being of Newborns. Chin Med J (Engl). 2015;128(14):1922-31.
67. Bliacheriene F, Carmona MJ, Barretti Cde F, Haddad CM, Mouchalwat ES, Bortolotto MR, et al. Use of a minimally invasive un-calibrated cardiac output monitor in patients undergoing cesarean section under spinal anesthesia: report of four cases. Rev Bras Anestesiol. 2011;61(5):610-8, 334-8.
68. McCarthy T, Telec N, Dennis A, Griffiths J, Buettner A. Ability of non-invasive intermittent blood pressure monitoring and a con-tinuous non-invasive arterial pressure monitor (CNAP) to provide new readings in each 1-min interval during elective caesarean section under spinal anaesthesia. Anaesthesia. 2012;67(3):274-9.
Science Citation Index Expanded (SciSearch) Created as SCI in 1964, Science Citation Index Expanded now indexes over 9,200 of the world’s most impactful journals across 178 scientific disciplines. More than 53 million records and 1.18 billion cited references date back from 1900 to present.
Journal Citation Reports/Science Edition Journal Citation Reports/Science Edition aims to evaluate a journal’s value from multiple perspectives including the journal impact factor, descriptive data about a journal’s open access content as well as contributing authors, and provide readers a transparent and publisher-neutral data & statistics information about the journal.
Chemical Abstracts Service Source Index The CAS Source Index (CASSI) Search Tool is an online resource that can quickly identify or confirm journal titles and abbreviations for publications indexed by CAS since 1907, including serial and non-serial scientific and technical publications.
Index Copernicus The Index Copernicus International (ICI) Journals database’s is an international indexation database of scientific journals. It covered international scientific journals which divided into general information, contents of individual issues, detailed bibliography (references) sections for every publication, as well as full texts of publications in the form of attached files (optional). For now, there are more than 58,000 scientific journals registered at ICI.
Geneva Foundation for Medical Education and Research The Geneva Foundation for Medical Education and Research (GFMER) is a non-profit organization established in 2002 and it works in close collaboration with the World Health Organization (WHO). The overall objectives of the Foundation are to promote and develop health education and research programs.
Scopus: CiteScore 1.3 (2023) Scopus is Elsevier's abstract and citation database launched in 2004. Scopus covers nearly 36,377 titles (22,794 active titles and 13,583 Inactive titles) from approximately 11,678 publishers, of which 34,346 are peer-reviewed journals in top-level subject fields: life sciences, social sciences, physical sciences and health sciences.
Embase Embase (often styled EMBASE for Excerpta Medica dataBASE), produced by Elsevier, is a biomedical and pharmacological database of published literature designed to support information managers and pharmacovigilance in complying with the regulatory requirements of a licensed drug.
Top