Severe Bradycardia during Spinal and Epidural Anesthesia Recorded by an Anesthesia Information Management System

Lesser, Jonathan B.; Sanborn, Kevin V.; Valskys, Rytis; Kuroda, Maxine M.

doi:10.1097/00000542-200310000-00018

Cited by 75 publications

(52 citation statements)

References 30 publications

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“…In adults, a HR of 60 min -1 should be considered a cut-off value for bradycardia after spinal anaesthesia only in pregnant women, which is a finding confirmed in literature reports [8,9]. The risk factors of moderate bradycardia include a baseline HR < 60 min -1 , male gender, age below 37 years, elective surgery, ASA I, and preoperative use of beta-adrenergic blocking agents [6]. In our population, the risk factors were predominantly the elective nature of surgery, ASA (I in 86% of individuals), and gender distribution; 46% of our patients were less than 37 years old, 8% had a baseline HR below 60 min -1 and none of our patients underwent beta-adrenolytic therapy.…”

Section: Discussionmentioning

confidence: 75%

“…Our findings regarding the incidence of decreased arterial pressure are comparable with those reported by other authors; the incidence of decreased HR found in our material differs from that presented in the literature. In a large population study of patients, the incidence of bradycardia has been estimated at approximately 9% for moderate bradycardia of 40-50 min -1 and at 0.7% for severe bradycardia, with an HR below 40 min -1 [6]. Because of noticeable inconsistencies in the cut-off value of HR, comparing results is difficult.…”

Section: Discussionmentioning

confidence: 99%

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Nieinwazyjna ocena układu krążenia przy użyciu urządzenia Nexfin pozwala na ocenę ryzyka wystąpienia hipotensji spowodowanej znieczuleniem podpajęczynówkowym

Ławicka¹,

Małek²,

Antczak³

et al. 2015

Anaesthesiol Intensive Ther

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Background: Unfavourable circulatory system conditions have been observed in many patients with spinal anaesthesia. The most frequent symptoms include a decrease in blood pressure and, less frequently, bradycardia. The appearance of unfavourable consequences of spinal anaesthesia might be related to the initial status of the patient's circulatory system. The aim of this study was to establish the possibility of predicting unfavourable circulatory consequences (hypotension, bradycardia) following spinal anaesthesia, based on non-invasive haemodynamic assessment with a Nexfin device. Methods: This prospective study included 100 18-60-year-old ASA I or II planned spinal anaesthesia patients. The initial hemodynamic parameters were assessed with a Nexfin monitor. Anaesthesia was performed with 3−3.5 mL of a 0,5% hyperbaric bupivacaine solution. Within 20 min after the administration of anaesthesia, the arterial blood pressure values, heart rate, sensory blockade level, and motoric blockade level were recorded in 5-min intervals. Hypotension was classified by a decrease of SAP < 90 mm Hg and/or the decrease of the SAP ≥ 20% initial value. Logistic regression was used to determine the independent predictors of hypotension resulting from a spinal blockade. Results: The development of hypotension and bradycardia was observed in 39 and 2%, respectively, of the patients. The patients who developed hypotension differed significantly from those who did not develop this symptom, with the main difference being the body mass and the assessment on the ASA scale. The patients who developed hypotension after spinal anaesthesia differed significantly in the initial hemodynamic parameters (SAP, MAP, SVRI). The following two independent risk factors for hypotension were isolated: the mean arterial pressure (OR 1.04; 95% CI: 1.005-1.076) and the systemic vascular resistance index (OR 1.109; 95% CI: 1.021-1.204). Conclusions: Nexfin-based non-invasive haemodynamic monitoring might be helpful in the identification of individuals with a high risk of hypotension following spinal blockade.

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Section: Discussionmentioning

confidence: 75%

Section: Discussionmentioning

confidence: 99%

Nieinwazyjna ocena układu krążenia przy użyciu urządzenia Nexfin pozwala na ocenę ryzyka wystąpienia hipotensji spowodowanej znieczuleniem podpajęczynówkowym

Ławicka¹,

Małek²,

Antczak³

et al. 2015

Anaesthesiol Intensive Ther

View full text Add to dashboard Cite

show abstract

“…The incidence of bradycardia in our study was 7.5% with bradycardia only in group H. The incidence was lower than in the study by Lesser et al (57), because in our study there was no bradycardia in group L. If we took into account only group H, the incidence was 15%, which was higher than published before. This was most probably the consequence of a higher spinal block, the average patients' age below 37 years, ASA1 and elective surgery, risk factors acknowledged also by other authors (1,57). The initial increase in HR 5 minutes after the block was most probably a compensatory response to a decrease in SVRI and it was probably also the consequence of a diminished parasympathetic activity to the heart (9, 18).…”

Section: Discussionmentioning

confidence: 88%

Comparison of haemodynamic parameters between the high and low spinal block in young healthy patients

2017

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Background: For some surgical procedures a higher sensory block is needed. However, it is complicated by a higher incidence of hypotension, more bradycardia and nausea and a higher use of vasoactive drugs. In elderly and obstetric population complications have been attributed to the decrease in cardiac output and systemic vascular resistance, especially in a high block (above Th6). The aim of our study was to find the incidence of hypotension and bradycardia after a spinal anaesthesia in young, healthy patients. As young patients compensate more, we aimed to find the difference in haemodynamic variables between the group with a high and the group with a low spinal block and the underlying mechanisms of hypotension. Methods: in a prospective, randomized study 44 ASA 1 patients scheduled for knee arthroscopy under spinal anaesthesia were randomly distributed to a high (group H) and a low (group L) spinal block group. In a group H patients were placed into horizontal, whereas in a group L in 15-degree anti-Trendelenburg position immediately after the spinal block. Haemodynamic parameters were measured continuously noninvasively from 10 min before to 25 min after the spinal block using the CNAPTM device with the LiDCORapid monitor. Results: The differences in haemodynamic parameters between the groups were not statistically significant at all measured times despite a significant difference in the spinal block level (18.5 vs 13.3 dermatomes above S5, p<0.001) and a significant

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“…This was most probably the consequence of a higher spinal block, the average patients' age below 37 years, ASA1 and elective surgery, risk factors acknowledged also by other authors. (1,57) The initial increase in HR 5 minutes after the block was most probably a compensatory response to a decrease in SVRI and it was probably also the consequence of a diminished parasympathetic activity to the heart. (9,18) Cook et al (9) showed an initial increase in HR of 6-8% after the spinal block, which was higher than in our study (5%).…”

Section: Discussionmentioning

confidence: 99%

Comparison of haemodynamic parameters between the high and low spinal block in young healthy patients

Poredoš¹,

Novak-Jankovič²

2017

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Background. For some surgical procedures a higher sensory block is needed. However, it is complicated by a higher incidence of hypotension, more bradycardia and nausea and a higher use of vasoactive drugs. In elderly and obstetric population complications have been attributed to the decrease in cardiac output and systemic vascular resistance, especially in a high block (above Th6). The aim of our study was to find the incidence of hypotension and bradycardia after a spinal anaesthesia in young, healthy patients. As young patients compensate more, we aimed to find the difference in haemodynamic variables between the group with a high and the group with a low spinal block and the underlying mechanisms of hypotension. Methods. In a prospective, randomized study 44 American Society of Anaesthesiologists (ASA) 1 patients scheduled for knee arthroscopy under spinal anaesthesia were randomly distributed to a high (group H) and a low (group L) spinal block group. In a group H patients were placed into horizontal, whereas in a group L in 15-degree anti-Trendelenburg position immediately after the spinal block. Haemodynamic parameters were measured continuously noninvasively from 10 min before to 25 min after the spinal block using the CNAPTM device with the LiDCORapid monitor. Results. The differences in haemodynamic parameters between the groups were not statistically significant at all measured times despite a significant difference in the spinal block level (18.5 vs 13.3 dermatomes above S5, p<0.001) and a significant difference in haemodynamic variables

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Severe Bradycardia during Spinal and Epidural Anesthesia Recorded by an Anesthesia Information Management System

Abstract: Moderate or severe bradycardia may occur at any time during neuraxial anesthesia, regardless of the duration of anesthesia. Low baseline heart rate increases the risk for bradycardia.

Cited by 75 publications

References 30 publications

Nieinwazyjna ocena układu krążenia przy użyciu urządzenia Nexfin pozwala na ocenę ryzyka wystąpienia hipotensji spowodowanej znieczuleniem podpajęczynówkowym

Nieinwazyjna ocena układu krążenia przy użyciu urządzenia Nexfin pozwala na ocenę ryzyka wystąpienia hipotensji spowodowanej znieczuleniem podpajęczynówkowym

Comparison of haemodynamic parameters between the high and low spinal block in young healthy patients

Comparison of haemodynamic parameters between the high and low spinal block in young healthy patients

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