Incidence and Time Course of Cardiovascular Side Effects During Spinal Anesthesia After Prophylactic Administration of Intravenous Fluids or Vasoconstrictors

Arndt, J. O.; Bomer, Walter; Krauth, J.; Marquardt, B

doi:10.1213/00000539-199808000-00021

Cited by 36 publications

(12 citation statements)

References 23 publications

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“…The most common and serious side effects from spinal anesthesia are hypotension and bradycardia [1,2] and closed claims surveys of 40,000-550,000 spinal anesthetics indicate an incidence of cardiac arrest from 0.04-1/10,000 [5,6]. Risk factors for hypotension are a sympathetic block height T5 or higher, age 40 years or older, baseline systolic blood pres-doi: 10.7243/2049-9752-4-5 sure less than 120 mmHg, and subarachnoid puncture site above L3-L4.…”

Section: Discussionmentioning

confidence: 99%

“…The most common and the most serious side effects of spinal anesthesia are hypotension (33%) and bradycardia (13%) [1,2]. Systemic vasodilation induced by sympathetic blockade after spinal anesthesia (SA), resulting in venous pooling of blood and reduction in systemic vascular resistance, has been regarded as the predominant mechanism for hypotension.…”

Section: Introductionmentioning

confidence: 99%

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Prophylactic use of IV atropine for prevention of spinal anesthesia induced hypotension and bradycardia in elderly: a randomized controlled trial

Sigdel¹

2015

J Anesthesiol Clin Sci

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Background: Spinal anesthesia induced hypotension is common and hazardous in elderly patients. Reversal of the blunted reflexes of tachycardia following hypotension in elderly with atropine helps in prevention of spinal anesthesia induced hypotension in elderly. Methodology: In this randomized, double-blind, controlled trial forty ASA PS I to II patients undergoing urological surgeries were assigned to receive either IV normal saline (placebo) or IV atropine 0.6 mg one minute after the induction of spinal anesthesia. Heart rate (HR), mean arterial pressure (MAP), requirement for mephentermine or phenylephrine, and the side effects profile were studied intra/postoperatively for 6 hours. Results:The patients were comparable with respect to demographic profile, baseline hemodynamic parameters, and the duration of surgery. Compared to baseline, mean HR and MAP were significantly reduced in the placebo group most of the study times (p<0.05). The incidence of hypotension was high in placebo (60%) compared to the atropine group (5%). Thus, the requirement of mephentermine for the management of hypotension was significantly higher (p<0.001) in the placebo group (60%) than the atropine group (5%). Conclusion: Intravenous administration of atropine 0.6 mg, one min after the induction of spinal anesthesia in an elderly patient, is a safe and effective method in the prevention of spinal anesthesia induced hypotension and bradycardia.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Prophylactic use of IV atropine for prevention of spinal anesthesia induced hypotension and bradycardia in elderly: a randomized controlled trial

Sigdel¹

2015

J Anesthesiol Clin Sci

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“…Hypotension during spinal anaesthesia may result in symptoms of nausea, vomiting and dizziness, but has also been shown to correlate with mortality [15]. Some studies have shown a reduction in spinal‐induced hypotension with the administration of prophylactic intravenous fluid [16] and vasopressor agents [17]. A Cochrane review concluded that hypotension resulting from spinal anaesthesia for Caesarean section can be reduced most effectively by the administration of prophylactic colloids and either ephedrine or phenylephrine [18].…”

Section: Discussionmentioning

confidence: 99%

Myocardial infarction associated with the administration of intravenous ephedrine and metaraminol for spinal‐induced hypotension

Khavandi¹,

Gatward²,

Whitaker³

et al. 2009

Anaesthesia

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SummaryA 31-year-old female with no risk factors for cardiac disease suffered a peri-operative myocardial infarction during an elective gynaecological procedure under spinal anaesthesia. The timing and nature of cardiac symptoms suggest that the myocardial infarction was caused by coronary artery vasospasm secondary to ephedrine and ⁄ or metaraminol, which were administered to treat spinalinduced hypotension. We review the recent literature and case reports on myocardial infarction attributed to sympathomimetic drugs, and recommend the use of sublingual or intravenous nitrates when signs or symptoms of coronary arterial vasospasm become evident during their use. Spinal anaesthesia is associated with cardiovascular complications, most notably hypotension and bradycardia [1], which often necessitate the use of sympathomimetic drugs such as ephedrine and metaraminol. These agents can cause coronary artery vasospasm, which is thought to be due to their action on alpha-adrenergic receptors on large epicardial arteries [2]. There have been several case reports of myocardial injury as a result of such vasospasm [3][4][5][6]. We describe a case of myocardial infarction in a fit, healthy woman, the signs and symptoms of which were closely temporally related to the administration of ephedrine and metaraminol for spinal-induced hypotension. Case reportA 31-year-old female with a history of stress incontinence was scheduled for an elective tension-free vaginal tape (TVT) procedure under spinal anaesthesia. She had previously received epidural analgesia, with no complications, for two normal vaginal deliveries. She had no history of cardiovascular disease and no risk factors. There was no history of illicit drug use. She was fit and healthy and regularly cycled 20 miles.Prior to insertion of the spinal anaesthetic, she was given 1 l of Hartmann's solution intravenously. She was very anxious about the procedure and so was given intravenous midazolam 2 mg in 1-mg increments. Blood pressure was recorded as 120 ⁄ 72 mmHg and heart rate 74 beats.min )1 . Spinal anaesthesia was induced with 2.7 ml hyperbaric bupivacaine 0.5%. Ten minutes after induction of anaesthesia, her blood pressure fell to 105 ⁄ 65 mmHg and her heart rate to 60 beats.min. She complained of feeling faint and became pale. She was treated with intravenous ephedrine 5 mg, followed by intravenous metaraminol 1 mg. Her blood pressure rose to 180 ⁄ 120 mmHg and she developed a sinus tachycardia of 120 beats.min )1 with frequent ventricular ectopic beats. This was associated with chest tightness and anxiety. She was given a further 2 mg intravenous midazolam in 1-mg increments. After 5 min, her chest discomfort had resolved and the procedure was completed without further complication or significant blood loss. She was transferred to the recovery room.

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“…As a side-effect, SPA may cause hypotension because of the sympathetic blockade. Therefore, fluid and/or vasopressor administration before or during spinal anaesthesia is frequently indicated to treat this condition (3). Therefore, fluid and/or vasopressor administration before or during spinal anaesthesia is frequently indicated to treat this condition (3).…”

mentioning

confidence: 99%

“…This effect is generally more severe in elderly patients (2). Therefore, fluid and/or vasopressor administration before or during spinal anaesthesia is frequently indicated to treat this condition (3).…”

mentioning

confidence: 99%

ACE inhibition does not exaggerate the blood pressure decrease in the early phase of spinal anaesthesia

Höhne

Meier²,

Boemke

et al. 2003

Acta Anaesthesiol Scand

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Long-term ACEI treatment does not further exaggerate the blood pressure decrease in the early phase of spinal anaesthesia. The increase in vasopressin concentrations in ACEI treated patients seems to be sufficient to compensate for the inhibited renin-angiotensin system. In addition, the transient increase in plasma norepinephrine, which occurs independent of preoperative ACEI treatment, seems to be involved in blood pressure regulation during spinal anaesthesia.

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Incidence and Time Course of Cardiovascular Side Effects During Spinal Anesthesia After Prophylactic Administration of Intravenous Fluids or Vasoconstrictors

Cited by 36 publications

References 23 publications

Prophylactic use of IV atropine for prevention of spinal anesthesia induced hypotension and bradycardia in elderly: a randomized controlled trial

Prophylactic use of IV atropine for prevention of spinal anesthesia induced hypotension and bradycardia in elderly: a randomized controlled trial

Myocardial infarction associated with the administration of intravenous ephedrine and metaraminol for spinal‐induced hypotension

ACE inhibition does not exaggerate the blood pressure decrease in the early phase of spinal anaesthesia

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