<p>Control of Spinal Anesthesia-Induced Hypotension in Adults</p>

Abstract

Spinal anesthesia-induced hypotension (SAIH) occurs frequently, particularly in the elderly and in patients undergoing caesarean section. SAIH is caused by arterial and venous vasodilatation resulting from the sympathetic block along with a paradoxical activation of cardioinhibitory receptors. Bradycardia after spinal anesthesia (SA) must always be treated as a warning sign of an important hemodynamic compromise. Fluid preloading (before initiation of the SA) with colloids such as hydroxyethyl starch (HES) effectively reduces the incidence and severity of arterial hypotension, whereas crystalloid preloading is not indicated. Co-loading with crystalloid or colloid is as equally effective to HES preloading, provided that the speed of administration is adequate (ie, bolus over 5 to 10 minutes). Ephedrine has traditionally been considered the vasoconstrictor of choice, especially for use during SAIH associated with bradycardia. Phenylephrine, a α 1 adrenergic receptor agonist, is increasingly used to treat SAIH and its prophylactic administration (ie, immediately after intrathecal injection of local anesthetics) has been shown to decrease the incidence of arterial hypotension. The role of norepinephrine as a possible alternative to phenylephrine seems promising. Other drugs, such as serotonin receptor antagonists (ondansetron), have been shown to limit the blood pressure drop after SA by inhibiting the Bezold-Jarisch reflex (BJR), but further studies are needed before their widespread use can be recommended.

Intercostal Catheters for Postoperative Pain Management in VATS Reduce Opioid Consumption

“…In the search for an ideal regional anaesthetic procedure, we were specifically looking for an easy-to-perform and time-saving procedure with a low risk for associated complications. While epidural anaesthesia achieves good pain control, it is time-consuming, difficult to perform, and has the risk of damaging the spinal cord and postoperative hypotension [ 5 , 6 , 7 ]. Therefore, the use of peridural analgesia in minimally invasive thoracic surgery remains a matter of debate [ 25 ].…”

“…TEA catheter placement is an effective method for postoperative pain control, but also carries specific risks (e.g., epidural hematoma or spinal cord injury) and is also time consuming, not only because of the procedure itself but also because of the management of frequently occurring hypotension, which develops in 36–75% of patients [ 5 , 6 , 7 ]. Additionally, reported failure rates of placed catheters range from 5.6% to 30% [ 8 , 9 ].…”

<p>Selective Spinal Anesthesia in a Patient with Low Ejection Fraction Who Underwent Emergent Below-Knee Amputation in a Resource-Constrained Setting</p>

“…Phenylephrine or noradrenaline can be used to treat SAIH and as a prophylactic administration. 18 In our patient, the goal was to maintain the patient's baseline mean blood pressure (87 mmHg) by applying the principles of unilateral SSA, and we were successful. We did not intend to preload or co-load him for the spinal block with a fear of acute exacerbation of CHF.…”

Venoarterial Extracorporeal Membrane Oxygenation as an Effective Therapeutic Support for Refractory Cardiac Arrest in the Setting of Spinal Anesthesia: A Case Report and Literature Review

“…6,8 Meanwhile, the loss of sympathetic tone results in peripheral vasodilation accompany with a redistribution of blood for splanchnic and limbs beds, which results in a significant reduction in cardiac preload. 2,9 Both the blockade of cardioaccelerator fibers and reduction of preload cause a negative impact in heart rate after spinal anesthesia. According to the findings of Carpenter et al, 10 sympathetic denervation seems to result in only a 10% drop in heart rate compared to baseline levels while maintaining full preload.…”