Central Noninvasive Hemodynamics in Combined Spinal Epidural Anesthesia with Expansion of the Epidural Space in Obese Patients
https://doi.org/10.21292/2078-5658-2021-18-6-90-96
Abstract
The objective: to substantiate the safety of using combined spinal epidural anesthesia with expansion of the epidural space in hernioplasty in obese patients.
Subjects and Methods. Hemodynamic parameters were studied in 100 obese patients who underwent elective hernioplasty of the anterior abdominal wall using the neuroaxial block of two types ‒ combined spinal epidural anesthesia with epidural volume extension (CSEA with EVE) and spinal anesthesia (SA). The patients were randomly divided into two groups: Group 1 (n = 60) ‒ patients operated under combined spinal epidural anesthesia with the epidural volume extension, Group 2 (n = 40) ‒ patients operated under spinal anesthesia. The assessment of changes in main parameters of central hemodynamics, stroke volume (SV), cardiac output (CO), and cardiac index (CI) was performed using the Estimated Continuous Cardiac Output technology based on the measurement of pulse wave transit time.
Results. It was revealed that in Group 1 patients, the listed parameters fluctuated slightly during the entire follow-up period. The average values were: SV 76.4 ± 0.37 ml, CO 5.8 ± 0.04 l/min, CI 3.56 ± 0.03 l/min/m2. In patients of Group 2, there was an increase in SV by 35.5%, CO by 24.2%, and CI by 23.6% at minutes 2-4 of the regional blockade.
Conclusions. The most obvious fluctuations in hemodynamic parameters are observed in the group of patients who underwent spinal anesthesia using relatively high doses of local anesthetic. When using CSEA with EVE with low doses of bupivacaine, stable hemodynamic parameters are noted with a constant level of the neuroaxial block.
About the Authors
N. V. Davydov
Samara State Medical University
Russian Federation
Russian Federation
Nikolay V. Davydov, Anesthesiologist and Emergency Physician of Anesthesiology and Intensive Care Department
165B, Karla Marksa Ave, Samara, 443079
Phone: +7 (846) 227–77–72
I. G. Trukhanova
Samara State Medical University
Russian Federation
Russian Federation
Inna G. Trukhanova, Doctor of Medical Sciences, Professor, Head of Anesthesiology, Intensive Care and Emergency Care Department, Postgraduate Training Institute
165B, Karla Marksa Ave, Samara, 443079
Phone: +7 (846) 227–77–72
А. D. Gureev
Samara State Medical University
Russian Federation
Russian Federation
Anton D. Gureev, Head of Anesthesiology and Intensive Care Unit, Assistant of Anesthesiology and Intensive Care Department
165B, Karla Marksa Ave, Samara, 443079
Phone: +7 (846) 227–77–72
Yu. G. Kutyreva
Samara State Medical University
Russian Federation
Russian Federation
Yulia G. Kutyreva, Candidate of Medical Sciences, Associate Professor of Anesthesiology, Intensive Care and Emergency Care Department, Postgraduate Training Institute
165B, Karla Marksa Ave, Samara, 443079
Phone: +7 (846) 227–77–72
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Review
For citations:
Davydov N.V., Trukhanova I.G., Gureev А.D., Kutyreva Yu.G. Central Noninvasive Hemodynamics in Combined Spinal Epidural Anesthesia with Expansion of the Epidural Space in Obese Patients. Messenger of ANESTHESIOLOGY AND RESUSCITATION. 2021;18(6):90-96. (In Russ.) https://doi.org/10.21292/2078-5658-2021-18-6-90-96
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