Abstract
Spinal anesthesia is popular for endoscopic urological surgery. Many patients undergoing urological surgery are elderly. It is important to limit the dose to reduce any resultant hemodynamic effect. We present a case in which incremental administration of 0.1 % bupivacaine up to 1.5 mg was sufficient to produce satisfactory spinal anesthesia for transurethral resection of bladder tumor (TURBT).
Highlights
Spinal anesthesia produces hypotension more often in elderly patients than in younger patients
Similar findings to the study of Baydilek et al were reported by others with spinal anesthesia for orthopedic lower extremity surgery [6,7,8,9,10,11], but none of them diluted the local anesthetic solution
Many articles suggest that the addition of fentanyl or sufentanil can enhance local anesthesia and thereby reduce the dose of local anesthetics with more stable hemodynamics for urological surgery [3, 20, 21] and other surgery [11, 22,23,24,25,26]
Summary
Spinal anesthesia produces hypotension more often in elderly patients than in younger patients. Limiting the dose (and extent of anesthetic spread) to the necessary dermatomes reduces the likelihood of side effects [1, 2]. We attempted to reduce the necessary amount of bupivacaine by dilution and incremental administration. Four ml of 0.5 % hyperbaric bupivacaine solution was diluted with 16 ml of normal saline to produce an approximately isobaric 0.1 % solution. Dopamine was continuously infused at 1.4–7.1 μg/kg/min to maintain an arterial blood pressure around 140/90 mmHg during surgery. The operation was finished uneventfully in 1 h His leg was paralyzed at the end of surgery but could be moved 2 h after the surgery. Both oxygen and dopamine could be discontinued 2 h after surgery.
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