The Effect of Patient Characteristics and the Spread of Spinal Anesthesia with 0.5% Hyperbaric Bupivacaine at Lateral Position
Mehmet Cantürk, Hakan Ateş, Meltem Hakkı, Nazan Kocaoğlu
department of anesthesiology and reanimation, kirsehir ahi evran university training and research hospital, kirsehir, turkey
BACKGROUND: Hyperbaric agents move more cephalad in trendelenburg position resulting in higher levels of spinal anesthesia. When positioned at lateral position on a horizontal operation table patients with larger hip/shoulder width ratio gain a relative trendelenburg position. We hypothesized that the increase in cephalad spread of spinal anesthesia with %0,5 hyperbaric bupivacaine may correlate with the increased hip/shoulder width ratio. The objective of the current study is to determine the effect of hip/shoulder width ratio, vertebral column length, patient age, height, weight and BMI on cephalad spread of spinal anesthesia. MATERIAL-METHODS: 60 ASA physical status I-II patients were enrolled in the study after informed patient consent and ethical committee approval (ACTRN12616000479404). Age, weight, height, body mass index, hip/shoulder width ratio, and vertebral column length were recorded for 60 patients. The L4-L5 interspace was introduced at lateral position and 3ml 0.5% hyperbaric bupivacaine was injected. Patient was turned supine 5 minutes after intrathecal injection. Correlation tests were performed for the relation between the spread of spinal anesthesia and the patient characteristics. RESULTS: Cephalad spread of spinal anesthesia has a positive correlation with hip/shoulder width ratio (p= 0,002), and a negative correlation with the height of the patients (p =0,026). Other patient variables considered in the study have no correlation with the cephalad spread of spinal anesthesia (p>0.05). Results and CONCLUSIONS: The cephalad spread of spinal anesthesia with a fixed dose of hyperbaric bupivacaine is affected by the hip/shoulder width ratio and the height of the patient when spinal anesthesia is performed at lateral position. As the patiets have increased hip/shoulder width ratio and shorter height, we may observe a larger spread of spinal anesthesia. Age, weight, BMI and vertebral column length has no effect.
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