Articles

The Hemodynamic Effects of Spinal Block with Low Dose of Bupivacaine and Sufentanil in Patients with Low Myocardial Ejection Fraction

Abstract

The aim of this study was to assess the effect of spinal block with low dose of bupivacaine and sufentanil on patients with low cardiac output who underwent lower limb surgery. Fifteen patients who had ejection fraction less than 40% (group 1) were compared with 65 cases with ejection fraction more than 40% (group 2) in our study. Our subjects underwent spinal block with 7.5 mg hyperbaric bupivacaine 0.5% and 5 µg sufentanil. We recorded early events such as hypotension, bradycardia, vasopressor need and ST segment change in our cases. The average mean arterial pressure decreased 13% (110 mmHg to 95.7 mmHg) in group 1 and 20% (160 mmHg to 128 mmHg) in group 2 (P<0.001). Hypotension due to spinal anesthesia was observed in none of our subjects in both groups and none of our cases need to vasopressor support. All patients remained alert, and no ST segment changes were observed in two groups. In our study none of subjects complained of pain intraoperatively. The subjects were without complaints during the spinal anesthetic in both groups. Spinal block with low dose local anesthetic and sufentanil was a safe and effective method for lower limb surgery in patients with low ejection fraction.

Wilkins K. Health care consequences of falls for seniors. Health Reports 1999;10(4):47–55.

Gullberg B, Johnell O, Kanis JA. World-wide projections for hip fracture. Osteoporosis Int 1997;7(5):407–13.

Beaupre LA, Jones CA, Saunders LD, Johnston DW, Buckingham J, Majumdar SR.. Best practices for elderly hip fracture patients. A systematic overview of the evidence. J Gen Intern Med 2005;20(11):1019–25.

Ben-David B, Frankel R, Arzumonov T, Marchevsky Y, Volpin G. Minidose bupivacaine-fentanyl spinal anaesthesia for surgical repair of hip fracture in the aged. Anesthesiology 2000;92(1):6–10.

Selda S, Aydin K, Discigil G. Hypotension induced by,lateral decubitus or supine spinal anesthesia in elderly with low ejection fraction undergoing hip surgery. Journal of Clinical Monitoring and Computing 2007;21(2):103–7

Lakatta EG, Gerstenblith G. Cardiovascular disorders. In: Evans JG, Williams TF, Beattie BL, Michel JP, Wilcock GK (eds) Oxford textbook of geriatric medicine. 2nd Edition. New York, Oxford University press 2000; 323–43.

Kim SY, Cho JE, Hong JY, Koo BN, Kim JM, Kil HK. Comparison of intrathecal fentanyl and sufentanil in low-dose dilute bupivacaine spinal anaesthesia for transurethral prostatectomy. Br J Anaesth 2009;103(5): 750-4.

Rooke GA, Freund PR, Jacobson AF. Jacobson. Hemodynamic Response and Change in Organ Blood Volume During Spinal Anesthesia in Elderly Men with Cardiac Disease. Anesth Analg 1997;85(1):99-105.

Chan VW, Chung F, Gomez M, Seyone C, Baylon G. Anesthetic and hemodynamic effects of single bolus versus incremental titration of hyperbaric spinal lidocaine through microcatheter. Anesth Analg 1994;79(1):117-23.

Fanelli G, Borghi B, Casati A, Bertini L, Montebugnoli M, Torri G. Unilateral bupivacaine spinal anaesthesia for outpatient knee arthroscopy. Can J Anesth 2000;47(8):746–51.

Elzinga L, Marcus M, Peek D, Borg P, Jansen J, Koster J, Enk D. Hemodynamic stability ensured by a low dose, low volume, unilateral hypobaric spinal block: modification of a technique. Acta Anaesthesiol Belg 2009;60(4):217-20.

Rooke GA, Robinson BJ. Cardiovascular and autonomic nervous system aging. Prob. Anaesthesia 1997;9:482–97.

Mebazaa MS, Ouerghi S, Ben Meftah R, Ben Cheikh M, Mestiri T, Ben Ammar MS. Reduction of bupivacaine dose in spinal anaesthesia for caesarean section may improve maternal satisfaction by reducing incidence of low blood pressure episodes. Middle East J Anesthesiol 2010;20(5):673-8.

Mayl GB, Lanea LF, Lynn-Schoomer MG. Effect of high spinal anesthesia on the cardiac output of normal and hypertensive patients. Am J Med 1949;7:251.

Roofthooft E, Van de Velde M. Low-dose spinal anaesthesia for Caesarean section to prevent spinalinduced hypotension. Curr Opin Anaesthesiol 2008;21(3):259-62.

Gudaityte J, Marchertiene I, Karbonskiene A, Saladzinskas Z, Tamelis A, Toker I, Pavalkis D. Low-dose spinal hyperbaric bupivacaine for adult anorectal surgery: a double-blinded, randomized, controlled study. J Clin Anesth 2009;21(7):474-81.

Carpenter RL, Caplan RA, Brown DL, Stephenson C, Wu R. Incidence and risk factors for side effects of spinal anesthesia. Anesthesiology 1992;76(6):906-16.

Akcaboy EY, Akcaboy ZN, Gogus N. Low dose levobupivacaine 0.5% with fentanyl in spinal anaesthesia for transurethral resection of prostate surgery. J Res Med Sci 2011;16(1):68-73.

Atalay C, Aksoy M, Aksoy AN, Dogan N, Kürsad H. Combining intrathecal bupivacaine and meperidine during caesarean section to prevent spinal anaesthesia-induced hypotension and other side-effects. J Int Med Res 2010;38(5):1626-36.

Kim SY, Cho JE, Hong JY, Koo BN, Kim JM, Kil HK. Comparison of intrathecal fentanyl and sufentanil in lowdose dilute bupivacaine spinal anaesthesia for transurethral prostatectomy. Br J Anaesth 2009;103(5):750-4.

Arzola C, Wieczorek PM. Efficacy of low-dose bupivacaine in spinal anaesthesia for Caesarean delivery: systematic review and meta-analysis. Br J Anaesth 2011;107(3):308-18.

Florio P, Puzzutiello R, Filippeschi M, D'Onofrio P, Mereu L, Morelli R, Marianello D, Litta P, Mencaglia L, Petraglia F. Low-dose spinal anesthesia with hyperbaric bupivacaine with intrathecal fentanyl for operative hysteroscopy: a caseseries study. J Minim Invasive Gynecol 2012;19(1):107-12.

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IssueVol 51, No 7 (2013) QRcode
SectionArticles
Keywords
Bupivacaine Ejection fraction Hypotension Spinal block

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1.
Sanatkar M, Sadeghi M, Esmaeili N, Sadrossadat H, Shoroughi M, Ghazizadeh S, Khoshraftar E, Pour Anvari H, Alipour N. The Hemodynamic Effects of Spinal Block with Low Dose of Bupivacaine and Sufentanil in Patients with Low Myocardial Ejection Fraction. Acta Med Iran. 1;51(7):438-443.