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Biphasic cardiac output changes during onset of spinal anaesthesia in elderly patients

Published online by Cambridge University Press:  01 September 2007

C. S. Meyhoff ,
L. Hesselbjerg ,
Z. Koscielniak-Nielsen  and
L. S. Rasmussen
C. S. Meyhoff*
Affiliation:
Copenhagen University Hospital, Centre of Head and Orthopaedics, Department of Anaesthesia, Rigshospitalet, Denmark
L. Hesselbjerg
Affiliation:
Copenhagen University Hospital, Centre of Head and Orthopaedics, Department of Anaesthesia, Rigshospitalet, Denmark
Z. Koscielniak-Nielsen
Affiliation:
Copenhagen University Hospital, Centre of Head and Orthopaedics, Department of Anaesthesia, Rigshospitalet, Denmark
L. S. Rasmussen
Affiliation:
Copenhagen University Hospital, Centre of Head and Orthopaedics, Department of Anaesthesia, Rigshospitalet, Denmark
*
Correspondence to: Christian Sylvest Meyhoff, Department of Anaesthesia, Centre of Head and Orthopaedics, Copenhagen University Hospital,Rigshospitalet, Copenhagen, DK-2100, Denmark. E-mail: meyhoff@rh.dk; Tel: +4535450958; Fax: +4535452950
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Summary

Background and objective

In most studies of cardiac output changes after spinal anaesthesia, the time-resolution is limited. The aim of this study was to demonstrate cardiac output changes with high time-resolution during onset of spinal anaesthesia in elderly patients.

Methods

We investigated 32 patients aged ⩾60 yr scheduled for elective lower limb surgery. Fourteen received concurrent cardiovascular medication. Cardiac output was measured every 10 s using a pulse wave algorithm derived from the radial artery pressure curve, after calibration with lithium chloride (LiDCO™plus). Data collection ended when the patients were ready for surgery, or if ephedrine was given to raise the mean arterial pressure.

Results

Cardiac output increased initially reaching a maximum after a mean of 7 min. The average increase was 1.1 L min−1 (P < 0.0001). This occurred when mean arterial pressure was reduced 14 mmHg on average. At the end of data collection, cardiac output decreased 0.5 L min−1 from baseline (P = 0.02). Mean arterial pressure decreased progressively in all patients, and only minimal changes in heart rate were found.

Conclusions

Using this high time-resolution method, we detected biphasic changes in cardiac output during onset of spinal anaesthesia. Initially, cardiac output increased. Subsequently, it was significantly reduced from baseline, although this decrease was of minor clinical importance.

Keywords

CARDIAC OUTPUTHYPOTENSIONINDICATOR DILUTION TECHNIQUESLITHIUM CHLORIDESPINAL ANAESTHESIA
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 24 , Issue 9 , September 2007 , pp. 770 - 775
Copyright
Copyright © European Society of Anaesthesiology 2007

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References

1.Greene, NM. Physiology of Spinal Anaesthesia. Baltimore: Williams & Wilkins, 1981.Google Scholar
2.Salinas, FV, Sueda, LA, Liu, SS. Physiology of spinal anaesthesia and practical suggestions for successful spinal anaesthesia. Best Pract Res Clin Anaesthesiol 2003; 17: 289–303.Google Scholar
3.Priebe, HJ. The aged cardiovascular risk patient. Br J Anaesth 2000; 85: 763–778.Google Scholar
4.Critchley, LA, Stuart, JC, Short, TG, Gin, T. Haemodynamic effects of subarachnoid block in elderly patients. Br J Anaesth 1994; 73: 464–470.Google Scholar
5.Rooke, GA, Freund, PR, Jacobson, AF. Hemodynamic response and change in organ blood volume during spinal anesthesia in elderly men with cardiac disease. Anesth Analg 1997; 85: 99–105.Google ScholarPubMed
6.Coe, AJ, Revanäs, B. Is crystalloid preloading useful in spinal anaesthesia in the elderly? Anaesthesia 1990; 45: 241–243.Google Scholar
7.Favarel-Garrigues, JF, Sztark, F, Petitjean, ME, Thicoipe, M, Lassie, P, Dabadie, P. Hemodynamic effects of spinal anesthesia in the elderly: single dose versus titration through a catheter. Anesth Analg 1996; 82: 312–316.Google Scholar
8.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: 117–123.CrossRefGoogle ScholarPubMed
9.Fanelli, G, Casati, A, Aldegheri, G et al. . Cardiovascular effects of two different regional anaesthetic techniques for unilateral leg surgery. Acta Anaesthesiol Scand 1998; 42: 80–84.CrossRefGoogle ScholarPubMed
10.Kamenik, M, Paver-Erzen, V. The effects of lactated Ringer’s solution infusion on cardiac output changes after spinal anesthesia. Anesth Analg 2001; 92: 710–714.Google Scholar
11.Donati, A, Mercuri, G, Iuorio, S et al. . Haemodynamic modifications after unilateral subarachnoid anaesthesia evaluated with transthoracic echocardiography. Minerva Anestesiol 2005; 71: 75–81.Google Scholar
12.Jonas, MM, Tanser, SJ. Lithium dilution measurement of cardiac output and arterial pulse waveform analysis: an indicator dilution calibrated beat-by-beat system for continuous estimation of cardiac output. Curr Opin Crit Care 2002; 8: 257–261.CrossRefGoogle ScholarPubMed
13.Carpenter, RL, Caplan, RA, Brown, DL, Stephenson, C, Wu, R. Incidence and risk factors for side effects of spinal anesthesia. Anesthesiology 1992; 76: 906–916.Google Scholar
14.Mark, JB, Slaughter, TF. Cardiovascular monitoring. In: Miller, R. ed. Miller’s Anesthesia. Philadelphia, USA: Elsevier Churchill Livingstone, 2005: 1265–1362.Google Scholar
15.Asehnoune, K, Larousse, E, Tadie, JM, Minville, V, Droupy, S, Benhamou, D. Small-dose bupivacaine–sufentanil prevents cardiac output modifications after spinal anesthesia. Anesth Analg 2005; 101: 1512–1515.Google Scholar
16.Tarkkila, PJ, Kaukinen, S. Complications during spinal anesthesia: a prospective study. Reg Anesth 1991; 16: 101–106.Google Scholar
17.Hartmann, B, Junger, A, Klasen, J et al. . The incidence and risk factors for hypotension after spinal anesthesia induction: an analysis with automated data collection. Anesth Analg 2002; 94: 1521–1529.CrossRefGoogle ScholarPubMed
18.Olofsson, C, Nygards, EB, Bjersten, AB, Hessling, A. Low-dose bupivacaine with sufentanil prevents hypotension after spinal anesthesia for hip repair in elderly patients. Acta Anaesthesiol Scand 2004; 48: 1240–1244.CrossRefGoogle ScholarPubMed
19.Farmer, MR, Vaile, JC, Osman, F, Ross, HF, Townend, JN, Coote, JH. A central gamma-aminobutyric acid mechanism in cardiac vagal control in man revealed by studies with intravenous midazolam. Clin Sci (London) 1998; 95: 241–248.CrossRefGoogle ScholarPubMed
20.Ikeda, T, Doi, M, Morita, K, Ikeda, K. Effects of midazolam and diazepam as premedication on heart rate variability in surgical patients. Br J Anaesth 1994; 73: 479–483.CrossRefGoogle ScholarPubMed
21.Taneyama, C, Goto, H, Kohno, N, Benson, KT, Sasao, J, Arakawa, K. Effects of fentanyl, diazepam, and the combination of both on arterial baroreflex and sympathetic nerve activity in intact and baro-denervated dogs. Anesth Analg 1993; 77: 44–48.Google Scholar
22.Hamilton, TT, Huber, LM, Jessen, ME. PulseCO: a less-invasive method to monitor cardiac output from arterial pressure after cardiac surgery. Ann Thorac Surg 2002; 74: S1408–S1412.Google Scholar
23.Linton, NW, Linton, RA. Estimation of changes in cardiac output from the arterial blood pressure waveform in the upper limb. Br J Anaesth 2001; 86: 486–496.CrossRefGoogle ScholarPubMed