ISSN 2415-3060 (print), ISSN 2522-4972 (online)
  • 22 of 61
УЖМБС 2019, 4(5): 149–153
Clinical Medicine

Hemodynamics in Different Types of Anesthesia Depending on the Initial Blood Circulation Regime during Spine Surgery in Prone Position

Lyzohub M. V.

During operations in prone position, the hemodynamics of the patient is influenced by two serious factors: anesthesia and the position during operation. Nonetheless, their influence prediction has not been thoroughly studied in modern literature. The purpose of the study was to justify the choice of anesthesia method for operations on the lumbar spine in the prone position. Material and methods. The study involved 254 patients who underwent planned surgery for degenerative diseases of the spine. The age of patients was between 16 and 77 years (45.8±11.7). There were 130 men (51.2%) and 124 women (48.8%). Before the operation, we examined hemodynamic changes when turning the patients to the prone position and chose the ones with labile reactions. Intraoperatively, hemodynamic reactions were compared when turning the patient to the prone position with spinal anesthesia (SА) with 0.5% hyperbaric solution of bupivacaine and total intravenous anesthesia (TIVA) based on propofol and fentanyl in standard doses. Results and discussion. With the initially stable blood circulation regime, turning the patients to the prone position led to more significant hemodynamic changes in SA group than in TIVA group, but these changes did not require correction with sympathomimetics. We recorded a significant decrease in cardiac index and specific peripheral vascular resistance in SA group. With the initially labile blood circulation in SA group, a decrease in peripheral vascular resistance, cardiac index and stroke volume index in 16 % of patients led to a decrease in mean arterial pressure below 60 mm Hg. which required the correction of hemodynamics with phenylephrine, which was not observed in TIVA group. Conclusions. Clinical assessment of hemodynamics with a change in body position in the preoperative period allowed identifying patients with labile reactions, who manifested a tendency to arterial hypertension and increase of peripheral vascular resistance. A greater risk of this condition occurred in younger individuals with an increased body mass index. SA inhibited the effects of the sympathoadrenal system more than propofol-based TIVA, which led to destabilization of hemodynamics in the labile circulation regime, and necessitated the introduction of α1-adrenomimetic phenylephrine. If a patient has initially labile hemodynamic response being turned to prone position, preference should be given to intravenous anesthesia based on propofol and fentanyl.

Keywords: hemodynamics, spine surgery, spinal anesthesia, intravenous anesthesia, prone position

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