EVALUATION OF CHANGE IN BLOOD PRESSURE IN REPOSITIONING FROM LITHOTOMY TO SUPINE POSITION IN PATIENTS UNDERGOING SURGERIES UNDER SUB-ARACHNOID BLOCK- AN OBSERVATIONAL STUDY

Abstract

Objective: Spinal anaesthesia is associated with variety of hemodynamic alterations, because of sympathetic blockade. Hemodynamics are also affected by a variety of surgical techniques. The lithotomy posture and the effects of autotransfusion increases the Systolic Arterial Pressure in the sub-extremities. Study was designed to evaluate the changes in blood pressure in repositioning from lithotomy position to supine position in patients undergoing surgeries under sub-arachnoid block. This Methods: observational study was performed in 41 patients who underwent for elective/ emergency surgeries under subarachnoid block requiring lithotomy position. Demographic information such as age, height, weight, BMI, ASA grade, height of sensory block, quality of motor block and hemodynamics such as Heart Rate (HR), Pulse Oximetry (SpO2), non invasive Blood Pressure (NIBP) during lithotomy position and repositioning to supine position were also recorded. In this study there is no signi Results: cant difference was observed in patients in repositioning from lithotomy position to supine position following sub-arachnoid block. There is slightly increased in Systolic blood pressure in patients in lithotomy position compared to supine position. This study was performe Conclusion: d on 41 patients who underwent surgeries under subarachnoid block requiring lithotomy position and this study concluded that there is no difference was observed in patients in repositioning from lithotomy position to supine position. The purpose of the study is to take necessary precautions will be taken to prevent blood pressure changes intraoperatively. Spinal anaesthesia is most commonly used neuro-axial anaesthesia technique, where the local anaesthesia is directly injected into the intrathecal space (sub-arachnoid block). The uid that surrounds the brain and spinal cord is called cerebro-spinal uid, is present in the sub-arachnoid region (1). Spinal Anaesthesia is usually given in patients in lateral position or sitting position, Trendelenburg position will produce higher level of block as compared to supine position (2). The spinal anaesthesia was rst performed in 1885 by Dr. James Corning of New York City. He used cocaine and the patient was a dog. However, August Bier performed the rst sub-arachnoid block surgery in Germany in 1898. Sub-arachnoid block is the type of regional anaesthetic that was most frequently used for obstetrics and caesarean sections after the 1950s (3). Spinal anaesthesia is used in patients undergoing procedures: femur, ankle orthopaedic hip, tibia and knee surgery, including haemorrhoidectomy and leg vascular surgery, Endovascular aortic aneurysm repair, joint replacement, arthroplasty, Hernia (inguinal or epigastric), Combined general anaesthesia and cystectomy, nephrectomy, transurethral resection of bladder tumours, Transurethral excision of the prostate and Caesarean sections, various hysterectomy methods, cases of urology. By using spinal anaesthesia, a patient can avoid the hazards of a difcult airway, consciousness, and aspiration that come with general anaesthesia in pregnant patients. By using spinal anaesthesia, a patient can avoid the hazards of a difcult airway, consciousness, and aspiration that come with general anaesthesia in pregnant patients. (4) . Hypotension is the most common complication of spinal anaesthesia, which is linked to a variety of haemodynamic abnormalities. The sympathetic blockade, which causes venous and arterial dilatation, are the primary mechanism (5). Total peripheral resistance reduces as a result of arterial dilatation, and cardiac output and venous return both decrease, which can result in severe hypotension (6). Hypotension do occur in almost all patients and signicant hypotension (systolic BP)