Hostname: page-component-586b7cd67f-2plfb Total loading time: 0 Render date: 2024-11-23T00:18:36.189Z Has data issue: false hasContentIssue false

Comparison of the effects of two intrathecal anaesthetic techniques for transurethral prostatectomy on haemodynamic and pulmonary function

Published online by Cambridge University Press:  11 July 2005

K. H. Walsh
Affiliation:
Cork University Hospital, Department of Anaesthesia, Wilton, Cork
C. Murphy
Affiliation:
Cork University Hospital, Department of Anaesthesia, Wilton, Cork
G. Iohom
Affiliation:
Cork University Hospital, Department of Anaesthesia, Wilton, Cork
C. Cooney
Affiliation:
Tallaght Hospital, Tallaght, Dublin, Ireland
J. McAdoo
Affiliation:
Cork University Hospital, Department of Anaesthesia, Wilton, Cork
Get access

Extract

Summary

Background and objective: Transurethral prostatectomy is routinely performed under spinal anaesthesia. This technique can cause hypotension, which is particularly undesirable in the elderly. The objective was to compare spinal anaesthesia for transurethral prostatectomy using hyperbaric bupivacaine 15 mg (control group) and hyperbaric bupivacaine 10 mg (limiting spread by maintaining the upright position for 15 min) and fentanyl 25 μg (fentanyl group) in terms of haemodynamic and pulmonary function.

Methods: Thirty ASA I–III patients were randomly selected and underwent spinal anaesthesia with either hyperbaric bupivacaine 15 mg (immediately positioned supine) or hyperbaric bupivacaine 10 mg (upright for 15 min) and fentanyl 25 μg.

Results: The greatest changes in mean arterial pressure (P = 0.9), ephedrine requirements (P = 0.8) and mean maximum change in forced vital capacity (P = 0.5) were similar in both groups.

Conclusions: The addition of fentanyl 25 μg to bupivacaine 10 mg and limiting the spread of the block does not improve either haemodynamic or pulmonary function compared with bupivacaine 15 mg in patients undergoing transurethral prostatectomy.

Type
Original Article
Copyright
© 2003 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

Raj PP, Gesund P, Phero J, et al. Rational choice for surgical procedures. In: Raj PP, ed. Clinical Practice of Regional Anesthesia. New York, USA: Churchill Livingstone, 1991: 231.
Greene NM, Brull SJ. The cardiovascular system. In: Greene NM, Brull SJ, eds. The Physiology of Spinal Anesthesia. Baltimore, USA: Williams & Wilkins, 1993: 85199.
Paskin S, Rodman T, Smith ST. The effect of spinal anesthesia on the pulmonary function of patients with chronic obstructive pulmonary disease. Ann Surg 1969; 169: 3541.Google Scholar
Hunt CO, Naulty JS, Bader AM, et al. Perioperative analgesia with subarachnoid fentanyl-bupivacaine for cesarean delivery. Anesthesiology 1989; 71: 535540.Google Scholar
Randalls B, Boardway JW, Browne DA, Morgan BM. Comparison of four subarachnoid solutions in a needle through needle technique for elective Caesarean section. Br J Anaesth 1991; 66: 314318.Google Scholar
Cousins MJ, Mather LE. Intrathecal and epidural administration of opioids. Anesthesiology 1984; 61: 2731.Google Scholar
Varessi G, Celleno D, Capogna G, et al. Ventilatory effects of subarachnoid fentanyl in the elderly. Anaesthesia 1992; 47: 558562.Google Scholar
Bernards CM. Epidural and spinal anesthesia. In: Barash PG, Cullen BF, Stoelting RK, eds. Clinical Anesthesia. Philadelphia, USA: Lippincott Williams & Wilkins, 2001: 694.
Tetzlaff JE. Spinal, epidural and caudal blocks. In: Morgan GE, Mikhael MS, eds. Clinical Anesthesiology. Stanford, USA: Appleton & Lange, 1996: 237.
Ben-David B, Frankel R, Arzumonov T, Marchevsky Y, Volpin G. Minidose bupivacaine–fentanyl spinal anesthesia for surgical repair of hip fracture in the aged. Anesthesiology 2000; 92: 610.Google Scholar
Beers RA, Kane PB, Nsouli I, Krauss D. Does a mid-lumbar block provide adequate analgesia for transurethral prostatectomy? Can J Anaesth 1994; 41: 807812.Google Scholar
Critchley LAH. Hypotension, subarachnoid block and the elderly patient. Anaesthesia 1996; 51: 11391143.Google Scholar
Ben-David B, Solomon E, Levin H, Admoni H, Goldik Z. Intrathecal fentanyl with small-dose bupivacaine: better anesthesia without prolonged recovery. Anesth Analg 1997; 85: 560565.Google Scholar
Brull SJ, Greene MN. Time-courses of zones of differential sensory blockade during spinal anaesthesia with hyperbaric tetracaine or bupivacaine. Anesth Analg 1989; 69: 342347.Google Scholar
Liu SS, Ware PD. Differential sensory block after spinal bupivacaine in volunteers. Anesth Analg 1997; 84: 115119.Google Scholar
Stevens RA, Beardsley D, White JL, Kao TC, Gantt R, Holman S. Does spinal anesthesia result in more complete sympathetic blockade than epidural anesthesia? Anesthesiology 1995; 82: 877883.Google Scholar
Coe AJ, Ravenas B. Is crystalloid preloading useful in spinal anaesthesia in the elderly? Anaesthesia 1990; 45: 241243.Google Scholar
Critchley LA, Short TG, Gin T. Hypotension during subarachnoid anaesthesia: haemodynamic effects of three treatments. Br J Anaesth 1994; 72: 151155.Google Scholar
Arndt JO, Bomer W, Krauth J, Marquardt B. Incidence and time course of cardiovascular side effects during spinal anaesthesia after prophylactic administration of intravenous fluids or vasoconstrictors. Anesth Analg 1998; 87: 347354.Google Scholar
Hemmingsen C, Poulsen JA, Risbo A. Prophylactic ephedrine during spinal anaesthesia: double blind study in patients in ASA groups I–III. Br J Anaesth 1989; 63: 340342.Google Scholar
Dahlgren G, Hulstrand C, Jakobsson J, Norman M, Eriksson EW, Martin H. Intrathecal sufentanil, fentanyl or placebo added to bupivacaine for cesarean section. Anesth Analg 1997; 85: 12881293.Google Scholar
Aldrete JA, Woodward ST, Turk LH. Influence of cigarette smoking on the changes produced by spinal anesthesia on expiratory forced volumes and flow rates. Anesth Analg 1973; 52: 809815.Google Scholar
Raj PP, Gesund P, Phero J, et al. Rational choice for surgical procedures. In: Raj PP, ed. Clinical Practice of Regional Anesthesia. New York, USA: Churchill Livingstone, 1991: 197.
Belzarena SD. Clinical effects of intrathecally administered fentanyl in patients undergoing cesarean section. Anesth Analg 1992; 74: 653657.Google Scholar