BACKGROUND AND OBJECTIVES: Heart rate variability (HRV), widely used as an indicator of activity of the autonomic nervous system, has been reported to decrease during and after both spinal and general anesthesia in patients without cardiovascular disease. We evaluated the changes in HRV bands in 40 patients with a high risk of ischemic heart disease. METHODS: The patients were randomly assigned to receive either spinal (SA) or general anesthesia (GA) for elective total hip arthroplasty or peripheral vascular surgery. Anesthetic techniques and perioperative fluid administration were standardized. Holter monitoring was started preoperatively and continued until the third postoperative day. Three HRV frequency bands were analyzed. RESULTS: A significant decrease was seen in very low frequency (VLF) and low frequency (LF) bands during GA but not during SA. Also the LF/high frequency (HF) ratio decreased during GA but not during SA. A decrease in all HRV frequency bands was seen after both types of anesthesia. None of the frequency bands returned back to the preoperative level during the 3-day trial. Postoperatively circadian variation was found only in the VLF band after SA. CONCLUSIONS: The sympathovagal balance (LF/HF) is more stable during SA than during GA in patients with a high risk of ischemic heart disease. The postoperative decrease in HRV bands, however, is independent of the anesthetic technique.

Aged↗

PubMedDate not supplied

Transient radicular irritation after bupivacaine spinal anesthesia.

BACKGROUND AND OBJECTIVES: Transient radicular irritation (TRI) has been described to occur following spinal anesthesia with hyperbaric 5% lidocaine. The authors recently used only isobaric or hyperbaric 0.5% bupivacaine for spinal anesthesia. All patients who had spinal anesthesia for various kinds of surgery were interviewed after the operation to discover the possibility of TRI following bupivacaine spinal anesthesia. METHODS: The study included 226 patients. Isobaric 0.5% bupivacaine was given to 116 patients and hyperbaric 0.5% bupivacaine to 110. The local anesthetic was chosen according to the expected duration of surgery. All patients were interviewed by an anesthesiologist 24 hours after spinal anesthesia, and after 1 week the patients were asked to return a written questionnaire. If pain not associated with operation was noted, the patients were interviewed by phone. RESULTS: One 48-year-old woman reported TRI after spinal anesthesia (saddle block) with hyperbaric 0.5% bupivacaine in the 24-hour interview. Her spinal anesthetic was performed in a sitting position and the anal surgery in a lithotomy position. In the 1-week questionnaire (response rate 92%), none of the other patients fulfilled our criteria for TRI. CONCLUSIONS: In spite of one case of TRI, the authors consider bupivacaine to be safe for spinal anesthesia. The association of the sitting and lithotomy positions to the restricted distribution of hyperbaric solution and consequent TRI warrants further studies.

Adolescent↗