Article

[Sudden bradycardia and hypotension in five patients under spinal anesthesia during transurethral resection of the prostate].

Department of Anesthesia, Sanraku Hospital, Tokyo 101-0062.
Masui. The Japanese journal of anesthesiology 10/2002; 51(9):992-5. pp.992-5
Source: PubMed

ABSTRACT We reported five patients had developed sudden bradycardia and hypotension under spinal anesthesia during transurethral resection of the prostate. The symptoms occurred not only just after the induction of spinal anesthesia, but also at the end of operation. It seems that these symptoms are caused from water intoxication, myocardial ischemia or vagal reflex. This emphasizes the importance of rigorous vigilance on patients until the end of operation.

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    Article: Prevention of postoperative hypotension following spinal anesthesia for TURP: a double-blind randomized controlled trial comparing ephedrine with placebo.
    J Verdeyen, J P Ory, W Wyckmans, E Vandermeersch, L Jamaer, A Van Assche
    [show abstract] [hide abstract]
    ABSTRACT: Spinal hypotension (SH) is a common side effect of spinal anesthesia and may also occur after the surgical procedure. In this double-blinded, placebo-controlled, randomised clinical trial fifty patients undergoing transurethral prostatectomy under spinal anesthesia received 10 mg of ephedrine IV before being transferred from the operating table into their bed after the procedure, whereas fifty controls received saline IV. The number of per- and postoperative hypotensive episodes and vasopressor use, time delay between the administration of the study medication and the first hypotensive episode, level of spinal blockade at the start of surgery, pre- and postoperative hemoglobine and sodium concentration, cardiovascular co-morbidity and chronic medication were registered. There was no statistically significant difference in the incidence of postoperative hypotension between the two groups, but Poisson regression of the expected number of postoperative hypotensive episodes per patient showed a protective effect of ephedrine (p < 0.05). The occurence of peroperative hypotension was a risk factor for developing postoperative hypotension (p < 0.05). There was no statistically significant relation between age, level of spinal blockade, cardiovascular co-morbidity or biochemical parameters and the risk of developing per- or postoperative hypotension, except for a correlation between preoperative alpha-receptor blocking drugs and peroperative hypotension (p < 0.05). Postoperative hypotension (recorded incidence 31%) was almost as common as peroperative hypotension (recorded incidence 37%) and occurred as late as 190 minutes after the end of surgery. Ephedrine IV at the end of surgery reduced the number of postoperative hypotensive episodes per patient but did not reduce the overall incidence of postoperative SH.
    Acta anaesthesiologica Belgica 01/2008; 59(2):73-8.
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Keywords

myocardial ischemia
 
prostate
 
rigorous vigilance
 
spinal anesthesia
 
sudden bradycardia
 
symptoms
 
transurethral resection
 
vagal reflex
 
water intoxication
 

Kazuyoshi Kawasaki