Hostname: page-component-78c5997874-j824f Total loading time: 0 Render date: 2024-11-05T09:38:05.017Z Has data issue: false hasContentIssue false
  • English
  • Français

Haemodynamic changes induced by hyperbaric bupivacaine during lateral decubitus or supine spinal anaesthesia

Published online by Cambridge University Press:  26 August 2005

J. D. Kelly ,
D. McCoy ,
S. H. Rosenbaum  and
S. J. Brull
J. D. Kelly
Affiliation:
St. Vincent's University Hospital, Department of Anaesthesia, Dublin
D. McCoy
Affiliation:
Cork University Hospital, Department of Anaesthesia, Wilton, Ireland
S. H. Rosenbaum
Affiliation:
Yale University School of Medicine, Department of Anesthesiology, New Haven, CT
S. J. Brull
Affiliation:
Mayo Clinic College of Medicine, Department of Anesthesiology, Jacksonville, FL, USA
Get access

Extract

Summary

Background and objective: Hypotension, the commonest side-effect of spinal anaesthesia, results from sympathetic denervation. This study compared patient positioning (supine vs. decubitus) on haemodynamic variables during spinal anaesthesia. Methods: After intravenous crystalloid preloading with 5 mL kg−1, hyperbaric bupivacaine 0.5% 2.5 mL was injected intrathecally at the L2–3 or L3–4 interspace. Patients were then randomly assigned to be positioned immediately supine and horizontal for 30 min (Group SUP, n = 12), or remained in the lateral decubitus position (fractured hip dependent) for 30 min (Group LAT, n = 14). Systolic blood pressure, mean arterial pressure, and loss of sensation of pinprick sensation were recorded prior to induction of spinal anaesthesia (baseline) and at 1, 2, 3, 5, 10, 15, 30, 45, 60, 90 and 120 min after intrathecal injection. Results: In Group SUP, the percent maximum systolic blood pressure (36 ± 13%) and percent maximum mean arterial pressure decreases (27 ± 13%) were significantly greater (P < 0.05) than in Group LAT (30 ± 8% and 23 ± 11%, respectively). Additionally, there was a borderline significant delay in the time to maximum systolic blood pressure decrease in Group LAT (38 ± 30 min) when compared with Group SUP (20 ± 17 min, P = 0.06), while the total dose of ephedrine required in the SUP group (30 mg) was greater than that required in the LAT group (15 mg, P = 0.05). In Group LAT patients, the mean level of denervation on the operative side extended 2 dermatomes more cephalad than in Group SUP. Conclusions: Lateral positioning for spinal anaesthesia delays the onset of hypotension, while requiring smaller total doses of vasoconstrictors for blood pressure maintenance.

Keywords

ANAESTHESIA, SPINAL, haemodynamic changesANAESTHETICS, LOCAL, bupivacainePOSITION, lateral, supineSYMPATHETIC NERVOUS SYSTEM, responses
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 22 , Issue 9 , September 2005 , pp. 717 - 722
Copyright
© 2005 European Society of Anaesthesiology

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Bier AKG. Experiments in cocainization of the spinal cord, 1899. In: Faulconer A, Keys ET, eds. Foundations of Anesthesiology. Springfield, IL: Charles C. Thomas, 1965.
Covino BG, Lambert DH. Epidural and spinal anesthesia. In: Barash PG, Cullen BF, Stoelting R, eds. Clinical Anesthesia. Philadelphia: JB Lippincott, 1992.
Moore DC, Bridenbaugh LD. Spinal (subarachnoid) block. A review of 11,574 cases. JAMA 1966; 195: 907–912.Google Scholar
Carpenter RL, Caplan RA, Brown DL, Stephenson C, Wu R. Incidence and risk factors for side effects of spinal anesthesia. Anesthesiology 1992; 76: 906–916.Google Scholar
Morgan P. The role of vasopressors in the management of hypotension induced by spinal and epidural anaesthesia. Can J Anaesth 1994; 41: 404–413.Google Scholar
Critchley LA, Short TG, Gin T. Hypotension during subarachnoid anaesthesia: haemodynamic analysis of three treatments. Br J Anaesth 1994; 72: 151–155.Google Scholar
Miyabe M, Sonoda H, Namiki A. The effect of lithotomy position on arterial blood pressure after spinal anaesthesia. Anesth Analg 1995; 81: 96–98.Google Scholar
Miyabe M, Namiki A. The effect of head-down tilt on arterial blood pressure after spinal anaesthesia. Anesth Analg 1993; 76: 549–552.Google Scholar
Lloyd SM, Reid J, Thorburn J. Failure to influence hypotension during spinal anaesthesia with a limb tourniquet. Acta Anaesthesiol Scand 1995; 39: 39–42.Google Scholar
Tanasichuk MA, Schultz EA, Matthews JH, Van Bergen FH. Spinal hemianalgesia: an evaluation of a method, its applicability, and influence on the incidence of hypotension. Anesthesiology 1961; 22: 74–85.Google Scholar
Brull SJ, Greene NM. The central nervous system. In: Brull SJ, Greene NM, eds. Physiology of Spinal Anaesthesia, 4th edn. Baltimore: Williams & Wilkins, 1993.
White JC, Smithwick RM, Simeone FA. The Autonomic Nervous System, 3rd edn. New York: The MacMillan Company, 1952.
Gissen AJ, Covino BG, Gregus J. Differential sensitivities of mammalian nerve fibers to local anesthetic agents. Anesthesiology 1980; 53: 467–474.Google Scholar
Wildsmith JA, Gissen AJ, Gregus J, Covino BG. Differential nerve blocking activity of amino-ester local anaesthetics. Br J Anaesth 1985; 57: 612–620.Google Scholar
Chamberlain DP, Chamberlain BD. Changes in the skin temperature of the trunk and their relationship to sympathetic blockade during spinal anesthesia. Anesthesiology 1986; 65: 139–143.Google Scholar
Greene NM. Area of differential block in spinal anesthesia with hyperbaric tetracaine. Anesthesiology 1958; 19: 45–50.Google Scholar
Malmquist LA, Bengtsson M, Bjornsson G, Jorfeldt L, Lofstrom JB. Sympathetic activity and haemodynamic variables during spinal analgesia in man. Acta Anaesthesiol Scand 1987; 31: 467–473.Google Scholar
Kim JM, LaSalle AD, Parmley RT. Sympathetic recovery following lumbar epidural and spinal analgesia. Anesth Analg 1977; 56: 352–355.Google Scholar
Bengtsson M, Loftstrom JB, Malmquist LA. Skin conductance responses during spinal analgesia. Acta Anaesthesiol Scand 1985; 29: 67–71.Google Scholar