Author/Editor		Zorko, Nuška; Kamenik, Mirt; Starc, Vito
Title		Vpliv Trendelenburgovega položaja, raztopine 6 % HES-a in Ringerjeve raztopine na hemodinamiko po subarahnoidni blokadi
Translated title		The effect of Trendelenburg position, lactated Ringer's solution and 6 % of Hydroxyethyl stach solution on cardiac output after spinal anesthesia
Type		članek
Source		In: Novak-Jankovič V, editor. Zbornik predavanj 5. slovenski kongres anesteziologov; 2009 maj 8-10; Portorož. Ljubljana: Slovensko združenje za anesteziologijo in intenzivno medicino, Slovensko zdravniško društvo,
Publication year		2009
Volume		str. 153-6
Language		slo
Abstract		The aim of our study was to evaluate the effects of Trendelenburg position combined with infusion of 6% hydroxyethyl starch solution or Ringer's solution on changes in cardiac output (CO) after spinal anesthesia in patients older than 50 years. Seventy patients scheduled for lower extremity orthopedic surgery under spinal anesthesia were allocated randomly to one of the three treatement groups. In the Trendelenburg group, the patients were placed in the Trendelenburg position immediately after the spinalblock for 10 minutes. In the hydroxyethyl starch group and the Ringer's solution group, the patients received an infusion of 500 ml of 6% hydroxyethyl starch solution or 1000 ml of Ringer's solution over 20 minutes after the spinal block. CO was measured continuously from 15 minutes before until 30 minutes after spinal anesthesia using the thoracic impedance cardiography method and arterial blood pressure with an automated device. P<0.05 was considered statistically significant. The differences among treatment groups in CO were not statistically significant. Differences in the CO changes from baseline over time were significant. In the Trendelenburg group, CO did not change while the patient was in the Trendelenburg position. In the hydroxyethyl starch group, CO increased significantly after the block and remained significantly increased until the end of measurements. In the Ringer's solutions group, CO increased significantly 10 and 20 minutes after the block, but after stopping the infusion, CO started to decrease. Our study demonstrated that a decrease in CO after spinal anesthesia is prevented by placing the patient in the Trendelenburg position, or infusion of either Ringer's solution or 6% hydroxyethyl starch solution. Although the effects of the infusion of the Ringer's solution are transient, the effects in the infusion of 6% hydroxyethyl starch solution are extended beyond the time of the infusion.
Summary		Namen raziskave je bila preučitev vpliva Trendelenburgovega položaja, 6% raztopine hidroksietil škroba in Ringerjeve raztopine na minutni volumen srca (MVS) po subarahnoidni blokadi pri bolnikih starejših od 50 let. 70 bolnikov, predvidenih za ortopedski operativni poseg spodnje okončine, je bilo naključno razdeljenih v tri skupine. V Trendelenburgovi skupini smo bolnike namestili v Trendelenburgov položaj po subarahnoidni blokadi za 10 minut. V skupini 6% hidroksietil škroba in Ringerjevi skupini so bolniki v 20 minutah prejeli 500 ml 6 % raztopine hidroksietil škroba oz. 1 000 ml Ringerjeve raztopine. MVS smo merili neprekinjeno 15 minut pred subarahnoidno blokado in 30 minut po subarahnoidni blokadi s pomočjo torakalne električne bioimpedance (TEB). Arterijski tlak smo merili pomočjo avtomatičnega merilca krvnega tlaka vsaki dve minuti in pol. Razlike MVS med tremi skupinami niso bile statistično značilne. Statistično značilne so bile spremembe MVS glede na izhodiščno vrednost. V Trendelenburgovi skupini se MVS ni značilno spremenil, dokler je bolnik ležal v Trendelenburgovem položaju. V skupini, ki je prejela 6 % raztopino hidroksietil škroba je MVS značilno porastel in ostal zvišan tudi po prekinitvi infuzije. V skupini, ki je prejela Ringerjevo raztopino je MVS statistično značilno porastel, vendar je po prekinitvi infuzije tudi značilno padel. Z raziskavo smo dokazali, da z namestitvijo bolnika v Trendelenburgov položaj, infuzijo 6% raztopine hidroksietil škroba in infuzijo Ringerjeve raztopine preprečimo znižanje MVS po subarahnoidni blokadi. Učinek Ringerjeve raztopine traja dokler infuzija teče, medtem ko je učinek infuzije 6 % raztopine prisoten še vsaj deset minut po prenehanju infuzije.
Descriptors		ANESTHESIA, SPINAL POSTURE CARDIAC OUTPUT HEMODYNAMICS INFUSIONS, INTRAVENOUS