Kemal BOZKURT, Süheyla KARADAĞ ERKOÇ, Çiğdem YILDIRIM GÜÇLÜ, Dilek YÖRÜKOĞLU

Spinal Anestezi Uygulanan Hipertansiyon Tanısı Olan Hastalarda Kristaloid İnfüzyonuna Başlama Zamanının Kan Basıncı Üzerine Etkisi

Amaç: Çalışmamızda spinal anestezi uygulanan hipertansiyon tanısı olan hastalarda kristaloid infüzyonuna başlama zamanının kan basıncı üzerine etkilerini retrospektif olarak araştırdık. Yöntem: Spinal anestezi uygulanan, hipertansiyon tanısı olan toplam 54 hasta anestezi gözlem kayıtları incelenerek bolus kristaloid infüzyonunun spinal anestezi uygulanmasından önce ve sonra yapılmasına göre iki gruba ayrıldı. I. Gruba (n=27) spinal anestezi uygulanmasından önce ve II. Gruba (n=27) spinal anestezi uygulanmasından sonra 15 ml kg-1 intravenöz kristaloid infüzyonunun ortalama 20 dakikada verildiği görüldü. Hastaların demografik verileri, hemodinamik parametreleri, sensöriyel ve motor blok seviyeleri, uygulanan vazopressör tedavi ve yan etkiler kaydedildi. Sistolik kan basıncının bazal SKB değerine göre %20’den daha fazla düşmesi veya SKB’nin 90 mmHg’nin altına inmesi hipotansiyon olarak kabul edildi. Bulgular: Gruplar arasında demografik veriler ve ameliyat süreleri açısından fark saptanmadı. Hipotansiyon görülme oranı tüm hastalarda %77.9 (Grup I’de %88.9, Grup II’de %77.8) bulundu. Sonuç: Çalışmamızda spinal anestezi uygulanan ve hipertansiyon tanısı olan hastalarda, kristaloidlerin spinal anestezi uygulanmadan önce bolus olarak verilmesi ya da spinal anesteziden sonra verilmesi hipotansiyon oranları üzerinde benzer sonuçlar oluşturdu.

The Effect of Start Time of Crystaloid Infusion on Blood Pressure in Patients With Hypertension Who Underwent Spinal Anesthesia

Objective: In our study we retrospectively investigated the effect of starting time of crystaloid infusion on blood pressure in patients with the diagnosis of hypertension who underwent spinal anesthesia. Methods: A total of 54 patients with the diagnosis of hypertension who underwent spinal anesthesia were divided into two groups according to whether bolus crystaloid infusion was performed before or after spinal anesthesia by reviewing observation records of anesthesia. 15 ml kg-1 intravenous of crystaloid infusion was given within an average 20 minutes for Group I (n=27) before spinal anesthesia and for Group II (n=27) after spinal anesthesia. Demographic data, hemodynamic parameters, sensory and motor block levels, vasopressor drug administration and side effects of the patients were recorded. Decrease in systolic blood pressure (SBP) more than 20% compared to baseline SBP or SBP below 90 mmHg was considered hypotension. Results: No difference was detected between the groups in terms of demographic data and operation time. It was found that the incidence of hypotension was 77.9% in all patients (88.9% in Group I, 77.8% in Group II). Conclusion: In our study, in patients with diagnosis of hypertension who underwent spinal anesthesia administration of crystaloids as bolus prior to spinal anesthesia or after spinal anesthesia had similar results on rates of hypotension.

PDF

___

Rout CC, Akoojee SS, Rocke DA, Gouws E. Rapid administration of crystalloid preload does not decrease the incidence of hypotension after spinal anaesthesia for elective caesarean section. Br J Anaesth. 1992;68:394-7. https://doi.org/10.1093/bja/68.4.394
Somboon Viboon W, Kyokong O, Charuluxananan S, Narasethakamol A. Incidence and risk factors of hypotension and bradycardia after spinal anesthesia for cesarean section. J Med Assoc Thai. 2008;91:181-7.
Hartmann B, Junger A, Klasen J, Benson M, Jost A, Banzhaf A, Hempelmann G. The incidence and risk factors for hypotension after spinal anesthesia induction: an analysis with automated data collection. Anesth Analg. 2002;94:1521-9.
Carpenter RL, Caplan RA, Brown DL, Stephenson C, Wu R. Incidence and riskfactors for side effects of spinal anesthesia. Anesthesiology. 1992;76:906-16. https://doi.org/10.1097/00000542-199206000-00006
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;57:24- 31. https://doi.org/10.1007/s12630-009-9206-7
Ni HF, Liu HY, Zhang J, Peng K, Ji FH. Crystalloid Coload Reduced the Incidence of Hypotension in Spinal Anesthesia for Cesarean Delivery, When Compared to Crystalloid Preload: A Meta-Analysis. Biomed Res Int. 2017;2017:3462529.
Ferré F, Marty P, Bruneteau L, et al. Prophylactic phenylephrine infusion for the prevention of hypotension after spinal anesthesia in the elderly: a randomized controlled clinical trial. Journal of Clinical Anesthesia. 2016;35:99-106. https://doi.org/10.1016/j.jclinane.2016.07.020
Minville V, Fourcade O, Grousset D, et al. Spinal anest-hesia using single injection small-dose bupivacaine versus continuous catheter injection techniques for surgical repair of hip fracture in elderly patients. Anesth Analg. 2006;102:1559-63. https://doi.org/10.1213/01.ane.0000218421.18723.cf
Lim HH, Ho KM, Choi WY, Teoh GS, Chiu KY. The use of intravenous atropin after a saline infusion in the prevention of spinal anesthesia-induced hypotension in elderly patients. Anesth Analg. 2000;91:1203-6.
Critchley LAH, Stuart JC, Short TG, Gin T. Haemodynamic effects of subarachnoid block in elderly patients. Br J Anaesth. 1994;73:464-70. https://doi.org/10.1093/bja/73.4.464
Buggy D, Higgins P, Moran C, O’Brien D, O’Donovan F, McCarroll M. Prevention of spinal anesthesia-induced hypotension in the elderly: comparison between preanesthetic administration of cristaloid, colloids and no prehydration. Anesth Analg. 1997;84:106-10. https://doi.org/10.1213/00000539-199701000-00020
Brown DL. Spinal, Epidural and Caudal Anesthesia In: Miller RD, ed. Miller’s Anesthesia. 6th ed. Philadelphia, Pennsylvania: Elsvier Churchhill Livingstone, 2005: Vol 2;1653-83.
Singla D, Kathuria S, Singh A, Kaul TK, Gupta S, Mamta. Risk factors for development of early hypotension during spinal anaesthesia. J Anaesth Pharmacol. 2006;22:387-93.
Kanbak M, Üzümcügil F. Hipertansiyon ve Anestezi. Turkiye Klinikleri J Anest Reanim-Special Topics. 2010;3:34-42.
Dagnino J, Prys-Roberts C. Studies of anaesthesia in relation to hypertension. VI.Cardiovascular responses to extradural blockade of treated and untreated hypertensive patients. Br J Anaesth. 1984;56:1065-71. https://doi.org/10.1093/bja/56.10.1065
Höhne C, Meier L, Boehmke W, Kaczmarczyk G. ACE inhibition does not exaggerate the blood pressure decrease in the early phase of spinal anaesthesia. Acta Anaesthesiol Scand. 2003;47:891-96. https://doi.org/10.1034/j.1399-6576.2003.00175.x