The Hemodynamic Effect of the Elevation of Lower Extemities during Hyperbaric Spinal Anesthesia

Kim, Yong Lak; Hong, Myoung Gie; Cho, Hyun Sung; Jung, Bu Jin; Lee, Kwan Woo

Abstract

Hypotension is one of the well-known complications following spinal anesthesia, and Trendelenburg position seems to have been used as one of the management of it. But, Trendelenburg position generally raises spinal anesthetic level with the use of hyperbaric tetracaine, and blood pressure may even further decrease. If simple elevation of lower extemities can prevent hypotension successfully without raising spinal anesthetic level following hyperbaric spinal anesthesia, there will be a possibility for us to replace Trendelenburg position with the elevation of lower extremities. We examined 50 cases of hyperbaric spinal anesthesia followed by elevation of lower extremities with the angles of l5 and 30 degrees. At each case, hydration with 10 ml per Kg was performed during the fixation time (about 30 minutes) and then, blood pressure(systolic and diastolic), heart rate were checked with the time-interval of 1 and 2 minutes for each angle. The paired T-test showed that systolic and diastolic blood pressure after spinal anesthesia was increased in all cases with mean values of 2.74~5.68 mmHg for systolic blood pressure(p<0.05) and 3.26~7.22 mmHg for diastolic blood pressure(p<0.05), and that heart rate was decreased by 3.54-5.82 beats per minute(p<0.05). In conclusion, simple elevation of lower extremities and routine hydration therapy seemed to elevate blood pressure, making it possible for us to consider elevation of lower extremities to prevent hypotension without raising spinal anesthetic level in routine hyperbaric spinal anesthesia.