Comparative Evaluation of Hemodynamic Changes in Different Positions in Normotensive Versus Hypertensive Patients Undergoing Percutaneous Nephrolithotomy (PCNL) Under Regional Anaesthesia

Abstract

Background: Hemodynamic changes occur with position change, are exaggerated under anesthesia and differ in magnitude between normotensive and hypertensive patients. Aim: To evaluate hemodynamic changes in different positions in 2 groups of patients: Normotensive versus Hypertensive undergoing PCNL under regional anaesthesia (RA). Methods: After ethical committee’s approval, a comparative study was conducted at a tertiary healthcare center, included 50 consenting patients >25 years age of ASA Class 1 and 2 undergoing PCNL under RA and divided into two groups of 25 patients each, Group 1-Normotensive patients and Group 2- Hypertensive patients. Hemodynamic variables (heart rate, Systolic, Diastolic and Mean arterial pressures, Electrocardiogram) were monitored throughout surgery and were recorded at Baseline (before instituting RA), Supine to Lithotomy, Lithotomy to Supine, Supine to Prone and Prone to Supine. Hypotensive episodes (Fall in systolic blood pressure (SBP) >20% from baseline) and vasopressor requirement (If SBP <80mm Hg then Inj. Ephedrine IV 5 mg given) were recorded in both the groups. Results: Statistical analysis was done using Chi-Square test and independent sample t test. Inter group comparison of hemodynamic parameters were comparable and statistically insignificant for all positions. Intragroup comparison of hemodynamic parameters showed lower readings as compared to baseline in all with respect to position change. Number of hypotensive episodes and vasopressor usedid not differ significantly betweentwo study groups. Conclusion: A well-controlled hypertensive patient behaves like a normotensive patient hemodynamically with respect to position change under anesthesia. Therefore, preoperative control of hypertension is essential. Keywords: PCNL; Regional anesthesia; Position change; Hypertension. Key Message: Control of hypertension enables a hypertensive patient to behave like a normotensive patient hemodynamically with respect to position change under anesthesia.