The Effect of Lower Extemities Elevation on Anesthetic Level and Vital Signs during Spinal Anesthesia

Lee, Sang Chul; Hong, Myung Gie; Lee, Kwan Woo

Abstract

Hypotension is frequently followed by spinal anesthesia using hyperbaric agents, and is one of the common, immediate complications of spinal anesthesia. Trendelenburg position has been used for the management of hypotension and shock since its first introduction in 1890. But this position may increase level of spinal anesthesia and decrease blood pressure even further in the hyperbaric spinal anesthesia. And it has been known that Trendelenburg position does not increase carotid blood flow in shock state. After all, Trendelenburg position seems to have little benefit in the management of hypotension during hyperbaric spinal anesthesia. If the simple elevation of lower extremities can raise blood pressure without greater cephalad spread, it will replace Trendelenburg position for the prevention and the management of hypotension during hyperbaric spinal anesthesia. We measured the changes of spinal anesthetic level, blood pressure and heart rate for 20 minutes during spinal anesthesia in the patients with 0degree 10degree,20degree and 30 leg elevation(10 patients for each group). Every patient was premedicated with 10mg of valium orally and hydrated with lactated Ringer's solution at the rate of 10 ml/minute during the whole procedure of this study. The analgesic levels (expressed as dermatome) were increased by 2 dermatomes at 20 minutes in comparison with the levels at 5 minutes after spinal anesthesia in all groups. The systolic blood pressure was decreased by 10% in 0degree-elevation group, by 15% in 10degree-elevation group, by 8% in 20degree- elevation group, and by 11% in 30degree-elevation group. But, there was no significant statistical difference in the changes of systolic blood pressure between any groups. Similar results were found in the changes of diastolic blood pressure and heart rate, which were not statistically significant, either. In conclusion, leg elevation from 10degree to 30degree is not recommended to prevent hypotension after hyperbaric spinal anesthesia, because leg elevation does not bring the changes of vital signs, although it causes no further raising of spinal anesthetic level.