DELIBERATE HYPOTENSION IN SOME OPERATION POSITIONS
Keywords:
controlled hypotension anaesthesia, prone position, beach-chair positionAbstract
Background. Controlled hypotension anaesthesia is used in different clinics since 1950s, and the number of methods is rather big. All of them provide better visualization of surgical field, but has serious limitations as to the potential risk of tissue hypoperfusion. This risk depends on the operation position as well. Aim of the study is to analyze the efficacy and safety of controlled with urapidil for spine surgery in prone position and shoulder surgery in beach-chair position. Methods. 58 patients who had undergone elective spinal surgery under general anaesthesia in the prone position (29 pts with controlled hypotension and 29 without), and 20 patients who had undergone elective shoulder surgery under interscalene block in the beach-chair position (10 pts with controlled hypotension and 10 without) were enrolled prospectively in this study. All patients underwent preand intraoperative blood pressure measurements, assignment of an ASA grade, and postoperative Bidway test after general anesthesia. The target MAP for all patients was 30% from baseline level. Controlled hypotension was performed with urapidil infusion. Results. Urapidil infusion in patients who had been operated in prone position allowed to decrease MAP from (92.5±7.1) mmHg to (63.8±2.0) mmHg. The course of hypotension was stable and no cerebral complications were observed. The course of controlled hypotension with urapidil in patients who were operated in the beach-chair position was not stable. Moreover several adverse effects occurred intraoperatively: nausea in 3 patients, vomiting in 1 patient and chest pain (without ECG changes) in 2 patients. Conclusions. Controlled hypotension with urapidil is effective and safe for spinal surgery in prone position. It should be used with cautious for shoulder surgery in the beach-chair position because of risk of cerebral and myocardial hypoperfusion.
References
Иркин О. И. Современная тактика лечения больных с гипертензивными кризами / О. И. Иркин, А. Н. Парфоменко // Медицина неотложных состояний. – 2010. – № 2. – С. 23–27.
Корекція артеріальної гіпертензії під час планових операційних втручань / І. І. Титов, В. В. Волошинський, І. Ю. Пулик [та ін.] // Біль, знеболювання і інтенсивна терапія. – 2012. – № 1. – C. 502–505.
Dippmann C. Severe cerebral desaturation during shoulder arthroscopy in the beach-chair position / C. Dippmann, S. Winge, H. B. Nielsen // Arthroscopy. – 2010. – N 26 (Suppl. 9). – Р. 148–150.
Haemodynamics and cerebral oxygenation during arthroscopic shoulder surgery in beach chair position under general anaesthesia / H. Jeong, S. H. Lee, E. A. Jang [et al.] // Acta Anaesthesiol Scand. – 2012. – N 56 (7). – Р. 872–879.
Deliberate hypotension in orthopedic surgery reduces blood loss and transfusion requirements: a meta-analysis of randomized controlled trials / J. E. Paul, E. Ling, C. Lalonde, L. Thabane // Can. J. Anaesth. – 2007. – N 54 (10). – Р. 799–810.
Pohl A. Cerebral ischemia during shoulder surgery in the upright position: a case series / A. Pohl, D. J. Cullen // J. Clin. Anesth. – 2005. – N 17 (6). – Р. 463–469.
Rodrigo C. Induced Hypotension During Anesthesia, with Special Reference to Orthognathic Surgery / C. Rodrigo // Anesth. Prog. – 1995. – N 42. – Р. 41–58.
