Volume 8, Issue 1 (2023)
SJMR 2023, 8(1): 37-42 |
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Nateghi M R, Saremi A, Abbasi B, Karimi MansoorAbad E. Balancing Blood Pressure: Understanding Hemodynamic Fluctuations in Spinal Anesthesia. SJMR 2023; 8 (1) : 5
URL: http://saremjrm.com/article-1-290-en.html
URL: http://saremjrm.com/article-1-290-en.html
1- Sarem Gynecology, Obstetrics and Infertility Research Center, Sarem Women's Hospital, Iran University of Medical Sciences (IUMS), Tehran, Iran
2- Sarem Gynecology, Obstetrics and Infertility Research Center, Sarem Women's Hospital, Iran University of Medical Sciences (IUMS), Tehran, Iran & Department of Medical Genetics, National Institute of Genetic Engineering and Biotechnology (NIGEB), Tehran, Iran
2- Sarem Gynecology, Obstetrics and Infertility Research Center, Sarem Women's Hospital, Iran University of Medical Sciences (IUMS), Tehran, Iran & Department of Medical Genetics, National Institute of Genetic Engineering and Biotechnology (NIGEB), Tehran, Iran
Abstract: (1379 Views)
Spinal anesthesia is a widely utilized technique in various surgical procedures, yet it presents the potential for hemodynamic fluctuations, manifesting as hypotension and hypertension. Understanding the underlying mechanisms and predisposing factors for these fluctuations is essential for optimizing patient care and outcomes especially in obstetrics settings. Hypotension during spinal anesthesia primarily results from sympathetic blockade-induced vasodilation and reduced systemic vascular resistance. Factors influencing its occurrence include the sensory block level, anesthesia onset speed, intravenous fluid volume and type, and baseline blood pressure. Hypertension may arise from sympathetic stimulation due to pain or anxiety during the procedure. Mechanisms contributing to hypertension encompass the renin-angiotensin-aldosterone system activation and increased norepinephrine release. The individual's baseline sympathetic tone, level of sympathetic blockade, and preexisting conditions, particularly in hypertensive patients, can influence these hemodynamic responses. Obstetric patients face additional challenges due to aortocaval compression in the supine position during pregnancy. Spinal anesthesia-induced hemodynamic fluctuations, encompassing both hypotension and hypertension, require careful consideration. Effective management strategies include fluid preloading, vasopressor administration for hypotension, and anxiolytic medications or short-acting antihypertensive agents for hypertension. Further research is needed to refine these strategies and enhance patient safety during spinal anesthesia, especially in populations with specific susceptibilities, such as hypertensive and obstetric patients.
Article number: 5
Keywords: Spinal Anesthesia, Hemodynamic Fluctuations, Hypotension, Hypertension, Obstetric Patients.
Article Type: Systematical Review |
Subject:
Pregnancy Care
Received: 2023/05/8 | Accepted: 2023/06/4 | Published: 2023/10/21
Received: 2023/05/8 | Accepted: 2023/06/4 | Published: 2023/10/21
References
1. Alimian, M., et al., Comparison of Hydroxyethyl Starch 6% and Crystalloids for Preloading in Elective Caesarean Section Under Spinal Anesthesia. Medical Archives, 2014. [DOI:10.5455/medarh.2014.68.279-281]
2. Gebrargs, L., et al., Comparison of Hemodynamic Response Following Spinal Anesthesia Between Controlled Hypertensive and Normotensive Patients Undergoing Surgery Below the Umbilicus: An Observational Prospective Cohort Study. Anesthesiology Research and Practice, 2021. [DOI:10.1155/2021/8891252]
3. Karaman, S., et al., Retrospective Evaluation of Anesthesia Approaches for Lumbar Disc Surgery. Journal of Anesthesia & Clinical Research, 2014. [DOI:10.4172/2155-6148.1000402]
4. Mostafa, M.M., et al., Hemodynamic Effects of Norepinephrine Versus Phenylephrine Infusion for Prophylaxis Against Spinal Anesthesia-Induced Hypotension in the Elderly Population Undergoing Hip Fracture Surgery: A Randomized Controlled Trial. Korean Journal of Anesthesiology, 2021. [DOI:10.4097/kja.20519]
5. Pasam, A., et al., Successful Regional Anesthetic for a Parturient With Moyamoya Syndrome. Case Reports in Anesthesiology, 2020. [DOI:10.1155/2020/1785041]
6. Rahmah, A., A. Utariani, and A. Basori, Profile Hemodynamics (Blood Pressure and Heart Rate) Changes in the Use of Adrenaline in Cesarean Section With Spinal Anesthesia at Dr Soetomo Surabaya Hospital. Indonesian Journal of Anesthesiology and Reanimation, 2020. [DOI:10.20473/ijar.V2I12020.27-32]
7. Su, M., Comparison of General Anesthesia With Endotracheal Intubation, Combined Spinal-Epidural Anesthesia, and General Anesthesia With Laryngeal Mask Airway and Nerve Block for Intertrochanteric Fracture Surgeries in Elderly Patients: A Retrospective Cohort Study. BMC Anesthesiology, 2019.
8. Kaimar, P., et al., A Comparison of Hypotension and Bradycardia Following Spinal Anesthesia in Patients on Calcium Channel Blockers and Β-Blockers. Indian Journal of Pharmacology, 2012.
9. Carvalho, B. and R.A. Dyer, Norepinephrine for Spinal Hypotension During Cesarean Delivery. Anesthesiology, 2015. [DOI:10.1097/ALN.0000000000000602]
10. Li, W. and K. Cui, Responses of Blood Pressure and Renal Sympathetic Nerve Activity to Colorectal Distension in Anesthetized Rats. The Journal of Physiological Sciences, 2006. [DOI:10.2170/physiolsci.RP001106]
11. Bashar, A., et al., Spinal Anesthesia for Cesarean Section in Preeclampsia. Journal of Surgical Sciences, 2020. [DOI:10.3329/jss.v22i1.44012]
12. Krum, H., et al., Diurnal Blood Pressure Variation in Quadriplegic Chronic Spinal Cord Injury Patients. Clinical Science, 1991. [DOI:10.1042/cs0800271]
13. Klasen, J., et al., Differing Incidences of Relevant Hypotension With Combined Spinal-Epidural Anesthesia and Spinal Anesthesia. Anesthesia & Analgesia, 2003. [DOI:10.1213/01.ANE.0000057601.90930.18]
14. Alemayehu, T.Y., et al., Hemodynamic Changes After Spinal Anesthesia in Preeclamptic Patients Undergoing Cesarean Section at a Tertiary Referral Center in Ethiopia: A Prospective Cohort Study. Patient Safety in Surgery, 2020. [DOI:10.1186/s13037-020-00234-w]
15. Kumar Babu, B.L.S., et al., Spinal Anesthesia a Better and Effective Alternative to General Aneasthesia in Spine Surgeries : A Prospective Open Label Single Arm Study. Journal of Evolution of Medical and Dental Sciences, 2014.
16. Nuradi, P., et al., The Potential of Granisetron in Preventing Spinal Anesthesia Induced Hypotension on Non-Obstetric Procedure.
17. Lairez, O., et al., Cardiovascular effects of low-dose spinal anaesthesia as a function of age: an observational study using echocardiography. Anaesthesia Critical Care & Pain Medicine, 2015. 34(5): p. 271-276. [DOI:10.1016/j.accpm.2015.02.007]
18. Aksoy, M., et al., Granisetron or ondansentron to prevent hypotension after spinal anesthesia for elective cesarean delivery: A randomized placebo-controlled trial. J Clin Anesth, 2021. 75: p. 110469. [DOI:10.1016/j.jclinane.2021.110469]
19. Massoth, C., L. Töpel, and M. Wenk, Hypotension after spinal anesthesia for cesarean section: how to approach the iatrogenic sympathectomy. Curr Opin Anaesthesiol, 2020. 33(3): p. 291-298. [DOI:10.1097/ACO.0000000000000848]
20. Wong, C.A., Spinal anesthesia-induced hypotension: is it more than just a pesky nuisance? Am J Obstet Gynecol, 2020. 223(5): p. 621-623. [DOI:10.1016/j.ajog.2020.08.105]
21. Yu, C., et al., Prediction of spinal anesthesia-induced hypotension during elective cesarean section: a systematic review of prospective observational studies. Int J Obstet Anesth, 2021. 47: p. 103175. [DOI:10.1016/j.ijoa.2021.103175]
22. Shitemaw, T., et al., Incidence and Associated Factors for Hypotension After Spinal Anesthesia During Cesarean Section at Gandhi Memorial Hospital Addis Ababa, Ethiopia. Plos One, 2020. [DOI:10.1371/journal.pone.0236755]
23. Nugroho, A.M., et al., A Comparative Study of Fractionated Versus Single Dose Injection for Spinal Anesthesia During Cesarean Section in Patients With Pregnancy-Induced Hypertension. Anesthesiology and Pain Medicine, 2019. [DOI:10.5812/aapm-85115]
24. Tatikonda, C.M., et al., Effect of Intravenous Ondansetron on Spinal Anesthesia-Induced Hypotension and Bradycardia: A Randomized Controlled Double-Blinded Study. Anesthesia Essays and Researches, 2019. [DOI:10.4103/aer.AER_22_19]
25. Palmer, C.M., Continuous Spinal Anesthesia and Analgesia in Obstetrics. Anesthesia & Analgesia, 2010. [DOI:10.1213/ANE.0b013e3181f7e3f4]
26. Bauer, M.E., et al., The Society for Obstetric Anesthesia and Perinatology interdisciplinary consensus statement on neuraxial procedures in obstetric patients with thrombocytopenia. Anesthesia & Analgesia, 2021. 132(6): p. 1531-1544. [DOI:10.1213/ANE.0000000000005355]
27. Gazdić, V., et al., Incidence of hypothension and bradicards during the spinal aneshesion in patients on beta-blockers therapy. Scripta
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