Analysis of the effectiveness of the use of spinal anesthesia in urological practice

Objective:

To evaluate the effectiveness of the use of spinal anesthesia (SA) in elderly patients of urological profile.

Materials and methods:

The studies were carried out on the basis of City Clinical Hospital №1 in Shymkent in 52 patients aged 65 to 84 years during operations: elimination of urethral stricture, transurethral resection of diffusely hyperplastic prostate gland. Concomitant pathology: hypertension (37%); Ischemic heart disease, angina pectoris (24.5%); COPD (14.0%). All patients underwent a standard preoperative examination, including general blood and urine analysis, biochemical blood test, coagulogram, electrocardiogram, chest X-ray, consultations of related specialists. The risk of anesthesia was assessed by stages 1-3 by ASA. Intraoperative monitoring included measuring blood pressure, heart rate, SpO2.

Within 50-80 minutes before the operation, up to 800.0 ml of crystalloid solutions were pre-infused. No premedication was performed.

In the sitting position of the patient, at the L3-L4 level, the spinal space was punctured with a Quincke needle (26g). After identification of the spinal canal, bupivacaine (0.5%) was administered at a dose of 10-15 mg.

The criteria for the effectiveness of anesthesia were determined by the visual analogue pain scale (VAS) intraoperatively and in the early postoperative period, motor block according to Bromage [1].

Observation results:

It was found that 27% of patients had hypotension with a decrease in SBP from the initial level to 30 mm Hg. For correction, the introduction of up to 1200 ml of crystalloids and 500 ml of gelofusin was used, 4% additionally required the use of dopamine[2] at a dose of 8-10 mcg / kg / min. In 12% of patients, for the purpose of sedation, diazepam[3] at a dose of 0.1-0.2 mg / kg / hour.

All patients had complete absence of pain during the operation. The sensory block remained up to the T12 level, the motor block: 3-4 st. In the postoperative period, the analgesic effect lasted up to 3-4 hours, which reduced the need for the use of analgesics by 2 times.

Conclusions:

The use of bupivacaine at a dose of 10-15 mg for SA in elderly patients showed an adequate level of anesthesia without significant hemodynamic disturbances.

Used literature: 1. M. Malroy, Local anesthesia, BINOM, 2007

2.Ronald Millers Anesthesia 2016.

3.Barash, Paul G.; Cullen, Bruce F.; Stoelting, Robert K. Clinical Anesthesia, 5th Edition Copyright ©2014

Lippincott Williams & Wilkins.

Year: 2020
City: Shymkent
Category: Medicine