Physiology of spinal anaesthesia and practical suggestions for successful spinal anaesthesia

Salinas, Francis V.; Sueda, Lila A; Liu, Spencer S.

doi:10.1016/s1521-6896(02)00114-3

Cited by 57 publications

(70 citation statements)

References 65 publications

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“…Reduction of cardiac output (CO) and systemic vascular resistance (SVR) are the main causes of significant hypotension (2). In young healthy normovolaemic patients SVR decreases approximately by 15-18% even with significant sympathetic blockade, mean arterial pressure decreases only by 15-18% and CO is maintained normal (1,2).…”

Section: Causementioning

confidence: 99%

“…In young healthy normovolaemic patients SVR decreases approximately by 15-18% even with significant sympathetic blockade, mean arterial pressure decreases only by 15-18% and CO is maintained normal (1,2). Preload is an important determinant of CO. CO depends on the patient positioning and remains unaffected if legs are elevated above the level of the heart (1).…”

Section: Causementioning

confidence: 99%

“…In elderly patients SVR decreases by 23-26%, central venous pressure by 2-3 mmHg, and left ventricular end diastolic volume decreases by 20% (2). Therefore, the haemodynamic effects are considerably notable and might be especially harmful to elderly patients with limited cardiac reserve compared with younger patients.…”

Section: Causementioning

confidence: 99%

“…Sympathectomy reduces the venous return to the heart, paradoxically, the vagal tone increases leading to marked bradycardia and asystole (2,6,7). The significant decrease in preload may initiate the following three reflexes which cause cardiovascular collapse and syncope (2,(5)(6)(7).…”

Section: Causementioning

confidence: 99%

“…The cardiovascular changes are the most important physiological responses to central neuraxial blockade: spinal, epidural and combined spinal epidural (CSE) anaesthesia (1,2). These responses are related with the autonomic denervation and higher levels of neural blockade, and vagal nerve innervations.…”

Section: Introductionmentioning

confidence: 99%

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Haemodynamic effects of central neural blocks

Borodičienė¹,

Gudaitytė²

2012

AML

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Haemodynamic effects are the most important physiological responses to central neural blocks. This article is focused on the etiology of hypotension, bradycardia and asystole understanding of which is essential for the anesthesiologist for successful management in the perioperative period. The main causes of cardiovascular changes are decreased cardiac output, systemic vascular resistance and reflexes related to baroreceptors. Hypotension and / or bradycardia are usually of short duration and easily treatable. However, haemodynamic changes in hypovolaemic, elderly patients with comorbidity, and patients with increased catecholamine production, due to excessive alcohol intake, emergency situation, can be significant with worse outcomes. Therefore it is essential to correct hypovolaemia before surgery. Timely notification, identification and appropriate treatment of haemodynamic changes caused by already performed central neural blockade remain important in the perioperative period as well. Vital functions must be monitored throughout surgery so that adverse cardiovascular reactions could be managed with timely and adequate treatment including elevation of the legs, oxygen and infusion therapy, vasoactive and anticholinergic drugs.

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Section: Causementioning

confidence: 99%

Section: Causementioning

confidence: 99%

Section: Causementioning

confidence: 99%