• D Holst, M Möllmann, S Karmann, and M Wendt.
• Klinik und Poliklinik für Anästhesiologie und Intensivmedizin Ernst-Moritz-Arndt-Universität Greifswald.
• Anaesthesist. 1997 Jan 1; 46 (1): 38-42.

UnlabelledLife-threatening cardiovascular complications are a serious risk even for healthy patients during spinal/epidural anaesthesia. The incidence of fatal cardiovascular complications for epidural anaesthesia is 1:10000, for spinal anaesthesia 1:7000. In contrast, general anaesthesia has an overall mortality of only 1:28000. Administration of IV fluids to minimise the haemodynaemic reactions of beginning sympatholysis is not always sufficient. In this study, we examined whether fractionated application of local anaesthetics via a spinal catheter would provide better haemodynamic stability.MethodsIn a prospective study, we examined the haemodynaemic reactions of 300 patients during single-dose (n = 150) versus continuous spinal anaesthesia (CSA) (n = 150). Isobaric bupivacaine 0.5% was given through a 29 G Quincke needle (3.5 ml) or a 28 G spinal catheter (1.5 ml as a bolus, followed by 1 ml/10 min until an anaesthetic level of T12 was reached).ResultsThe sensory and motor effects of both methods were comparable. The T12 level of anaesthesia was achieved with the single-dose method after 10.5 min and with the continuous method after 19.1 min. After single-dose anaesthesia, the blood pressure dropped by 16.5% and the heart rate by 12% compared to the control values. During CSA no significant blood pressure changes were recorded; the heart rate decreased by 8%. In 15 cases vasoconstrictors had to be given to stabilise the lowered blood pressure after single-dose anaesthesia.ConclusionWith the use of CSA, the haemodynamic effects of sympatholysis can be minimised. This method thus has advantages, especially for high-risk cardiovascular patients.

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