Mehmet TOPTAŞ, Sinan UZMAN, İlke İŞİTEMİZ, Tümay Uludağ YANARAL, İbrahim AKKOÇ, Gülşen BİCAN

A comparison of the effects of hyperbaric and isobaric bupivacaine spinal anesthesia on hemodynamics and heart rate variability

To compare the effects of hyperbaric and isobaric bupivacaine spinal anesthesia on hemodynamics and heart rate variability (HRV) in nonobstetric surgery. Materials and methods: Sixty patients were randomly allocated to 2 groups. Group I (n = 30) received 15 mg (3 mL) of hyperbaric bupivacaine and Group II (n = 30) received 15 mg (3 mL) of isobaric bupivacaine for spinal anesthesia. Hemodynamic parameters were recorded before and after spinal anesthesia over 30 min. Analyses of HRV were performed on the day of surgery, after volume loading, and 20 min after spinal injection. Low frequency (LF) values, high frequency (HF) values, and LF/HF ratios were recorded. The incidences of hypotension and alterations of HRV parameters in both groups were investigated. Results: The incidence of hypotension was 26.6% and 23.3% in Groups I and II, respectively. There were no significant differences in the LF and HF values and LF/HF ratios between groups. In Group I, LF/HF ratios were significantly lower and HF values were significantly higher at 20 min after spinal anesthesia, in comparison to the baseline value (P < 0.05). Conclusion: Hyperbaric bupivacaine caused a significantly greater decrease in LF/HF ratios and a significantly greater increase in HF values.

Anahtar Kelimeler:

Key words: Spinal anesthesia, bupivacaine, heart rate variability, hypotension

A comparison of the effects of hyperbaric and isobaric bupivacaine spinal anesthesia on hemodynamics and heart rate variability

Keywords:

Key words: Spinal anesthesia, bupivacaine, heart rate variability, hypotension,

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Wong JO, Tan TD, Leung PO, Tseng KF, Cheu NW, Tang CS. Comparison of the effect of two different doses of 0.75% glucose-free ropivacaine for spinal anesthesia for lower limb and lower abdominal surgery. Kaohsiung J Med Sci 2004; 20: 423–30.
Urmey WF. Spinal anaesthesia for outpatient surgery. Best Pract Res Clin Anaesthesiol 2003; 17: 335–46.
O’Donnell BD, Iohom G. Regional anesthesia techniques for ambulatory orthopedic surgery. Curr Opin Anaesthesiol 2008; 21: 723–8.
Stamer UM, Wiese R, Stüber F, Wulf H, Meuser T. Change in anaesthetic practice for Caesarean section in Germany. Acta Anaesthesiol Scand 2005; 49: 170–6.
Klasen J, Junger A, Hartmann B, Benson M, Jost A, Banzhaf A, Kwapisz M, Hempelmann G. Differing incidences of relevant hypotension with combined spinal-epidural anesthesia and spinal anesthesia. Anesth Analg 2003; 96: 1491–5.
Mojica JL, Meléndez HJ, Bautista LE. The timing of intravenous crystalloid administration and incidence of cardiovascular side effects during spinal anesthesia: the results from a randomized controlled trial. Anesth Analg 2002; 94: 432–7.
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.
Brenck F, Hartmann B, Katzer C, Obaid R, Brüggmann D, Benson M, Röhrig R, Junger A. Hypotension after spinal anesthesia for cesarean section: identification of risk factors using an anesthesia information management system. J Clin Monit Comput 2009; 23: 85–92.
Hanss R, Bein B, Ledowski T, Lehmkuhl M, Ohnesorge H, Scherkl W, Steinfath M, Scholz J, Tonner PH. Heart rate variability predicts severe hypotension after spinal anesthesia for elective cesarean delivery. Anesthesiology 2005; 102: 1086–
Hanss R, Bein B, Francksen H, Scherkl W, Bauer M, Doerges V, Steinfath M, Scholz J, Tonner PH. Heart rate variabilityguided prophylactic treatment of severe hypotension after subarachnoid block for elective cesarean delivery. Anesthesiology 2006; 104: 635–43.
Tetzlaff JE, O’Hara J, Bell G, Grimm K, Yoon HJ. Influence of baricity on the outcome of spinal anesthesia with bupivacaine for lumbar spine surgery. Reg Anesth 1995; 20: 533–7.
Critchley LA, Morley AP, Derrick J. The influence of baricity on the haemodynamic effects of intrathecal bupivacaine 0.5%. Anaesthesia 1999; 54: 469–74.
Rofaeel A, Lilker S, Fallah S, Goldszmidt E, Carvalho J. Intrathecal plain vs hyperbaric bupivacaine for labour analgesia: efficacy and side effects. Can J Anaesth 2007; 54: 15–
Hallworth SP, Fernando R, Columb MO, Stocks GM. The effect of posture and baricity on the spread of intrathecal bupivacaine for elective cesarean delivery. Anesth Analg 2005; 100: 1159–65.
Hanss R, Ohnesorge H, Kaufmann M, Gaupp R, Ledowski T, Steinfath M, Scholz J, Bein B. Changes in heart rate variability may reflect sympatholysis during spinal anesthesia. Acta Anaesthesiol Scand 2007; 51: 1297–304.
Introna R, Yodlowski E, Pruett J, Montano N, Porta A, Crumrine R. Sympathovagal effects of spinal anesthesia assessed by heart rate variability analysis. Anesth Analg 1995; 80: 315–21.
Heart rate variability: standards of measurement, physiological interpretation, and clinical use. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. Eur Heart J 1996; 17: 354–81.
Brown DL. Spinal, epidural and caudal anesthesia. In: Miller RD, editor. Miller’s Anesthesia. 7th ed. Philadelphia, PA, USA: Churchill Livingstone Elsevier; 2010. pp. 1611–38.
Carpenter RL, Caplan RA, Brown DL, Stephenson C, Wu R. Incidence and risk factors for side effects of spinal anesthesia. Anesthesiology 1992; 76: 906–16.
Singla D, Kathuria S, Singh A, Kaul TK, Gupta S, Mamta. Risk factors for development of early hypotension during spinal anesthesia. J Anaesth Pharmacol 2006; 22: 387–93.
Van Gessel EF, Forster A, Schweizer A, Gamulin Z. Comparison of hypobaric, hyperbaric, and isobaric solutions of bupivacaine during continuous anesthesia. Anesth Analg 1991; 72: 779–84.
Solakovic N. Level of sensory block and baricity of bupivacaine 0.5% in spinal anesthesia. Med Arh 2010; 64: 158–60.
Kooger Infante NE, Van Gessel E, Forster A, Gamulin Z. Extent of hyperbaric spinal anesthesia influences the duration of spinal block. Anesthesiology 2000; 92: 1319–23.
Charkoudian N, Rabbitts JA. Sympathetic neural mechanisms in human cardiovascular health and disease. Mayo Clin Proc 2009; 84: 822–30.
Lombardi F, Stein PK. Origin of heart rate variability and turbulence. an appraisal of autonomic modulation of cardiovascular function. Front Physiol 2011; 95: 1–7.
Yazıcı M, Uzun K, Ülgen MS, Teke T, Maden E, Kayrak M, Turan Y, Arı H. The acute effect of bi-level positive airway pressure on heart rate variability in chronic obstructive pulmonary disease patients with hypercapnic respiratory failure. Anadolu Kardiyol Derg 2008; 8: 426–30.
Hanss R, Bein B, Weseloh H, Bauer M, Cavus E, Steinfath M, Scholz J, Tonner PH. Heart rate variability predicts severe hypotension after spinal anesthesia. Anesthesiology 2006; 104: 537–45.
Arakawa M, Goto F. Power spectral analysis of heart rate and blood pressure variability in lumbar epidural anaesthesia. Can J Anaesth 1994; 41: 680–7.
Fujiwara Y, Kurokawa S, Shibata Y, Asakura Y, Harado M, Komatsu T. Sympathovagal effects of spinal anaesthesia with intrathecal or intravenous fentanyl assessed by heart rate variability. Acta Anaesthesiol Scand 2009; 53: 476–82.
Pomeranz B, Macaulay RJ, Caudill MA, Kutz I, Adam D, Gordon D, Kilborn KM, Barger AC, Shannon DC, Cohen RJ et al. Assessment of autonomic function in human by heart rate spectral analysis. Am J Physiol 1985; 248: 151–53.
Pagani M, Lombardi F, Guzzetti S, Rimoldi O, Furlan R, Pizzinelli P, Sandrone G, Malfatto G, Dell’Orto S, Piccaluga E et al. Power spectral analysis of heart rate and arterial pressure variabilities as a marker of sympatho-vagal interaction in man and conscious dog. Circ Res 1986; 59: 178–93.
Dantas EM, Gonçalves CP, Silva AB, Rodrigues SL, Ramos MS, Andreão RV, Pimentel EB, Lunz W, Mill JG. Reproducibility of heart rate variability parameters measured in healthy subjects at rest and after a postural change maneuver. Braz J Med Biol Res 2010; 43: 982–8.
Tetzlaff JE, O’Hara J Jr, Yoon HJ, Schubert AG. Heart rate variability and the prone position under general versus spinal anesthesia. J Clin Anesth 1998; 10: 656–9.
Bridenbaugh PO, Greene NM, Brull SJ. Spinal (subarachnoid) neural blockade. In: Cousins MJ, Bridenbaugh PO, editors. Neural Blockade in Clinical Anesthesia and Management of Pain. 3rd ed. Philadelphia, PA, USA: Lippincott Raven; 1998. pp. 203–41.
Meyhoff CS, Haarmark C, Kanters JK, Rasmussen LS. Is it possible to predict hypotension during onset of spinal anesthesia in elderly patients? J Clin Anest 2009; 21: 23–9.