• P Lipfert and J O Arndt.
• Institut für Experimentelle Anaesthesiologie und Abteilung für Klinische Anaesthesiologie, Heinrich-Heine-Universität Düsseldorf.
• Anaesthesist. 1993 Nov 1;42(11):773-87.

AbstractMajor conduction anaesthesia is not harmless. Based on new findings about sympathetic blockade, it was analysed whether circulatory side effects after spinal or epidural anaesthesia, in particular cardiocirculatory arrest, correlate with the level of segmental spread and whether prophylactic or therapeutic measures are effective. With spinal or epidural anaesthesia in healthy, unpremedicated patients, blood pressure, heart rate, and cardiac output remain within +/- 20% of normal independent of the height of segmental spread. However, in patients with circulatory diseases and/or premedication blood pressure often drops more than 20%, especially when cranial spread exceeds T4. Cardiocirculatory arrest during major conduction anaesthesia: (1) is preceded by an interval of 10-20 min recognisable by narrowing of the pulse pressure and continuous decreases in blood pressure and heart rate; (2) does not correlate with the level of segmental spread; and (3) is possibly caused by reduced filling of the heart and/or vagal activity. Infusion of crystalloid or colloid solutions may diminish the drop in blood pressure, whereas vasopressors reduce the frequency and extent of cardiocirculatory side effects. As yet, however, there is no safe prophylaxis to prevent cardiocirculatory arrest. Cardiopulmonary resuscitation after circulatory arrest must be combined with early administration of catecholamines.

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