Prediction of the development of arterial hypotension at the stroke of the patient on stomach on the background of spinal anesthesia

Authors

DOI:

https://doi.org/10.15587/2519-4798.2019.169496

Keywords:

spinal anesthesia, hemodynamics, abdominal position, lumbar spine

Abstract

When conducting spinal anesthesia (SA) in a position on the abdomen, arterial hypotension may occur, which is due to anesthesia and the effect of the position itself on the blood flow. The aim of the work was the development of a prognostic model for changes in hemodynamics in vertebrologic operations in the abdomen on the background of spinal anesthesia.

Materials and methods. Postural blood circulation reactions were studied in 144 patients of the orthopedic profile operated in the abdominal position under spinal anesthesia: in the position on the back, after 5 and 20 minutes after turning on the stomach. Previously (one day before surgery) the same reactions were studied without anesthesia.

Results. In 16.0±3.1 % of patients during SA, hemodynamic correction with α1-adrenomimetics was required after rotation on the stomach. A randomized analysis of changes in hemodynamics before and during anesthesia revealed in these patients the stress of blood flow compensation, which was manifested when rotated to the abdomen without anesthesia in arterial hypertension and increased general peripheral vascular resistance. Under the influence of SA this compensation was suppressed, which led to instability of blood circulation. Significant risk of such a complication occurred in younger patients and with increased BMI. According to the results of the retrospective analysis, a mathematical model has been developed that allows calculating the prognostic index of hemodynamic instability (PING) and predicting hemodynamic instability during SA in the presence of abdominal patient. The PING value can range from infinitesimal to 1.

Conclusions: before conducting surgical interventions in the abdominal position under SA it is expedient to preoperatively study postural blood flow reactions with the calculation of PING. With PING>0.5 you should refrain from conducting CA and choose another kind of anesthesia.

Author Biographies

Mykola Lyzohub, SI “Sitenko Institute of Spine and Joint Pathology NAMS of Ukraine” Pushkinska str., 80, Kharkiv, Ukraine, 61024

PhD, Associate Professor, Head of Department

Department of Anesthesiology and Intensive Therapy

Marine Georgiyants, Kharkiv Medical Academy of Postgraduate Education Amosova str., 58, Kharkiv, Ukraine, 61176

MD, Professor, Vice Rector for Research

Department of Pediatrics Anesthesiology and Intensive Therapy

Olena Visotska, National Aerospace University H. E. Zhukovsky «Kharkiv Aviation Institute» Chkalova str., 17, Kharkiv, Ukraine, 61070

Doctor of Technical Sciences, Professor, Head of Department

Department of radio-electronic and biomedical computer-aided means and Technologies

Kostiantyn Mykhnevych, Kharkiv National Medical University Nauky ave., 4, Kharkіv, Ukraine, 61022

PhD, Associate Professor

Department of Critical Care Medicine, Anesthesiology and Intensive Therapy

Andrii Porvan, National Aerospace University H. E. Zhukovsky «Kharkiv Aviation Institute», Chkalova str., 17, Kharkiv, Ukraine, 61070

PhD, Associate Professor

Department of radio-electronic and biomedical computer-aided means and technologies

References

  1. Edgcombe, H., Carter, K., Yarrow, S. (2008). Anaesthesia in the prone position. British Journal of Anaesthesia, 100 (2), 165–183. doi: http://doi.org/10.1093/bja/aem380
  2. Lessing, N. L., Edwards, C. C., Brown, C. H., Ledford, E. C., Dean, C. L., Lin, C., Edwards, C. C. (2016). Spinal Anesthesia in Elderly Patients Undergoing Lumbar Spine Surgery. Orthopedics, 40 (2), e317–e322. doi: http://doi.org/10.3928/01477447-20161219-01
  3. Chinachoti, T., Tritrakarn, Т. (2007). Prospective study of hypotension and bradycardia during spinal anesthesia with bupivacaine: incidence and risk factors, part two. Journal of the Medical Association of Thailand, 90 (3), 492–501.
  4. Bible, J. E., Mirza, M., Knaub, M. A. (2018). Blood-loss Management in Spine Surgery. Journal of the American Academy of Orthopaedic Surgeons, 26 (2), 35–44. doi: http://doi.org/10.5435/jaaos-d-16-00184
  5. Ławicka, M., Małek, A., Antczak, D., Wajlonis, A., Owczuk, R. (2015). Non-invasive haemodynamic measurements with Nexfin predict the risk of hypotension following spinal anaesthesia. Anestezjologia Intensywna Terapia, 47 (4), 303–308. doi: http://doi.org/10.5603/ait.2015.0048
  6. Wu, C.-Y., Lee, T.-S., Chan, K.-C., Jeng, C.-S., Cheng, Y.-J. (2012). Does targeted pre-load optimisation by stroke volume variation attenuate a reduction in cardiac output in the prone position. Anaesthesia, 67 (7), 760–764. doi: http://doi.org/10.1111/j.1365-2044.2012.07116.x
  7. Filho, G., Garcia, J., Goldschimidt, R., Mago, A., Cordeiro, M., Ceccato, F. (2001). Predictors of early hypotension during spinal anesthesia. Revista Brasileira de Anestesiologia, 51 (4), 298–304. doi: http://doi.org/10.1590/s0034-70942001000400004
  8. Sakata, K., Yoshimura, N., Tanabe, K., Kito, K., Nagase, K., Iida, H. (2017). Prediction of hypotension during spinal anesthesia for elective cesarean section by altered heart rate variability induced by postural change. International Journal of Obstetric Anesthesia, 29, 34–38. doi: http://doi.org/10.1016/j.ijoa.2016.09.004
  9. Behunov, A. A., Shyhaev, M. Yu., Shyhaev, Yu. H. (2010). Pat. No. 2383298 RU. Sposob prognozirovanija potrjebnosti korrekcii gemodinamiki pri provedenii regionarnoi anestesii s klofelinom [Prognostic Method of Requirements of Hemodynamic Correction During Regional Anesthesia with Clonidine]. МPK: А61В 5/02, А61М 19/00, А61К31/4168, А61P 9/02. No. 2008142334/14; declareted: 24.10.2008; published: 10.03.2010.
  10. Lyzohub, M. V., Georgiyants, M. A., Vysotska, O. V., Porvan, A. P., Lyzohub, K. I. (2019). Pat. No. 131991 UA. Sposib prognozuvannja nespryiatlyvyh zmin hemodynamiky na phoni spinalnoii anesthesiii [Prognostic method of unfavourable hemodynamic changes during spinal anesthesia]. MPK: А61В 5/02. No. u 2018 08333; declareted: 30.07.2018; published: 11.02.2019, Bul. No. 3.
  11. Shimizu, M., Fujii, H., Yamawake, N., Nishizaki, M. (2015). Cardiac function changes with switching from the supine to prone position: Analysis by quantitative semiconductor gated single-photon emission computed tomography. Journal of Nuclear Cardiology, 22 (2), 301–307. doi: http://doi.org/10.1007/s12350-014-0058-3
  12. Tabara, Y., Tachibana-Iimori, R., Yamamoto, M., Abe, M., Kondo, I., Miki, T., Kohara, K. (2005). Hypotension Associated with Prone Body Position: A Possible Overlooked Postural Hypotension. Hypertension Research, 28 (9), 741–746. doi: http://doi.org/10.1291/hypres.28.741
  13. Hofhuizen, C., Lemson, J., Snoeck, M., Scheffer, G.-J. (2019). Spinal anesthesia-induced hypotension is caused by a decrease in stroke volume in elderly patients. Local and Regional Anesthesia, 12, 19–26. doi: http://doi.org/10.2147/lra.s193925

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Published

2019-06-25

How to Cite

Lyzohub, M., Georgiyants, M., Visotska, O., Mykhnevych, K., & Porvan, A. (2019). Prediction of the development of arterial hypotension at the stroke of the patient on stomach on the background of spinal anesthesia. ScienceRise: Medical Science, (3 (30), 4–9. https://doi.org/10.15587/2519-4798.2019.169496

Issue

No. 3 (30) (2019)

Section

Medical Science

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Copyright (c) 2019 Mykola Lyzohub, Marine Georgiyants, Olena Visotska, Kostiantyn Mykhnevych, Andrii Porvan

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