CARDIOVASCULAR STABILITY DURING SPINAL-AN ESTHESIA - CATHETER TECHNIQUE IN COMPARISON WITH THE SINGLE-DOSE METHOD

Life-threatening cardiovascular complications are a serious risk even for healthy patients during spinal/epidural anaesthesia. The incidence of fatal cardiovascular complications for epidural anaesthesia is 1:1 0000, for spinal anaesthesia 1:7000. In contrast, general anaesthesia has an overall mortality of only 1:28000. Administration of IV fluids to minimise the haemodynaemic reactions of beginning sympatholysis is not always sufficient. In this study, we examined whether fractionated application of local anaesthetics via a spinal catheter would provide better haemodynamic stability. Methods: In a prospective study, we ex amined the haemodynaemic reactions of 300 patients during single-dose (n=150) versus continuous spinal anaesthesia (CSA) (n=150). Isobaric b upivacaine 0.5% was given through a 29 G Quincke needle (3.5 ml) or a 28 G spinal catheter (1.5 ml as a bolus, followed by 1 ml/10 min until an anaesthetic level of T12 was reached). Results: The sensory and mo tor effects of both methods were comparable. The T12 level of anaesthe sia was achieved with the single-dose method after 10.5 min and with t he continuous method after 19.1 min. After single-dose anaesthesia, th e blood pressure dropped by 16.5% and the heart rate by 12% compared t o the control values. During CSA no significant blood pressure changes were recorded; the heart rate decreased by 8%. In 15 cases vasoconstr ictors had to be given to stabilise the lowered blood pressure after s ingle-dose anaesthesia. Conclusion: With the use of CSA, the haemodyna mic effects of sympatholysis can be minimised. This method thus has ad vantages, especially for high-risk cardiovascular patients.