Abstract
Purpose
The haemodynamic effects of crystalloid preload were evaluated in a randomised blind study in 20 ASA status I–II, 50–60 yr-old patients, undergoing unilateral spinal anaesthesia for leg surgery produced with low doses of hyperbaric bupivacaine.
Methods
Baseline non-invasive blood pressure (oscillometry), heart rate, stroke volume and cardiac index (transthoracic electrical bioimpedance) were recorded. Then, patients were randomly allocated to receive 10 ml · kg−1 Ringer’s Lactate solution over 20 min (preload group, n= 10) or no crystalloid infusion (no-preload group. n= 10). Spinal block was performed using 8 mg hyperbaric bupivacaine 0.5% injected slowly at the L2-L3 interspace (0.02 ml · sec−1 through a 25-gauge Whitacre needle) with patients lying on their operated side and with the needle opening directed towards the dependent side. Lateral decubitus position was maintained for up to 15 min after anaesthetic injection to facilitate hyperbaric bupivacaine distribution towards dependent regions of the subarachnoid space. Haemodynamic variables were recorded 5, 10, 15 and 30 min after spinal injection, while sensory level and motor block were evaluated 10, 15 and 30 min after anaesthetic injection on both operated and unoperated side.
Results
No differences of upper sensory level and motor block were observed between the two groups on the operated and non-operated sides. Diastolic blood pressure was decreased compared with baseline m the no — preload group only (P = .0001). Systolic arterial pressure and heart rate did not change in either group. Stroke volume and cardiac index were decreased in the no-preload group compared with both baseline (P =.02: P = .001) and the preload group (P = .04; P = .02).
Conclusion
Crystalloid preload influences cardiovascular function during spinal block, and may be useful when very low bupivacaine doses and lateral decubitus are used to achieve unilateral spinal block.
Résumé
Objectif
Les effets hémodynamiques de la précharge aux cristalloïdes ont été évalués au cours d’une étude aléatoire à double insu chez 20 patients de 50 à 80 ans ASA I et II soumis à une rachianesthésie hyperbare avec de faibles doses de bupivacaïne pour un chirurgie du membre inférieur.
Méthodes
Les valeurs initiales de la pression artérielle non invasive (oscillométne), de la fréquence cardiaque, du volume d’éjection et de l’index cardiaque (par bioimpedance transthoracique électrique) ont d’abord été enregistrées. Les patients répartis en deux groupes ont reçu 10 ml · kg−1 d’une solution de latíate de Ringer sur une période de 20 min (groupe précharge, n = 10) ou aucun cnstalloïtie (groupe sans précharge. n = 10). La rachianesthésie a été réalisée avec 8 mg de bupivacaine hyperbare 0,5% injectée lentement à L2–L3 (0.02 ml sec−1 à travers une aiguille Whitacre 25 G) en position latérale sur le côté opéré avec l’orifice de l’aiguille dirigé vers le bas. La position de décubitus latéral a été maintenue pendant 15 min après l’injection de l’anesthésique pour favoriser la distribution hyperbare de la bupivacaine vers les régions déclives de l’espace sous-arachnoïdien. Les vanables hémodynamiques ont été enregistrées 5, 10, 15 et 30 min après l’injection et les niveaux sensitifs et moteurs évalués dans les deux hémicorps 10, 15 et 30 min après l’injection de l’anesthésique.
Résultats
Aucune différence n’a été observée en ce qui concerne le bloc sensitivomoteur entre les deux groupes que ce soit du côté de l’opération ou de l’autre côté. La pression diastolique baissait comparativement à la ligne de base dans le groupe sans précharge seulement (P < 0,0001). La pression arténlle systolique et la fréquence cardiaque sont demeurées les mêmes dans les deux groupes. Le volume d’éjection et l’index cardiaque diminuaient dans le groupe sans précharge comparativement aux valeurs de base (P = 0.02; P = 0,001) et au groupe précharge (P = 0,04; P = 0.02).
Conclusion
La précharge aux cristalloïdes influence la fonction cardiovasculaire pendant la rachianesthésie et peut être utile quand de très faibles doses de bupivacaïne sont administrées en association avec le décubitus latéral pour produire une rachianesthésie unilatérale.
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Casati, A., Fanclli, G., Berti, M. et al. Cardiac performance during unilateral lumbar spinal block after crystalloid preload. Can J Anaesth 44, 623–628 (1997). https://doi.org/10.1007/BF03015446
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DOI: https://doi.org/10.1007/BF03015446