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Year 2021 Vol. 29 No 1

REVIEWS

A.M. OVECHKIN, S.V. SOKOLOGORSKY, M.E. POLITOV

SPINAL ANESTHESIA AND HYPOTENSION: MECHANISMS, RISK FACTORS, PROPHYLAXIS AND CORRECTION

Sechenov First Moscow State Medical University (Sechenov University), Moscow,
The Russian Federation

Hypotension is the most common adverse effect of spinal anesthesia (SA). The insidence of SA-induced hypotension in the total population is 15-33%, in patients of older age groups it reaches 80%. At young and middle ages, the main determinant of SA-induced hypotension is considered to be a reduction of postload and venous reflux, due to blood deposition in capacitance vessels of the lower extremities. The aortocaval compression syndrome plays a significant role in obstetric practice, cardiac output does not change. In elderly patients, the main prerequisite for the development of hypotension is an enhanced basal sympathetic tone on the background of SA. In patients of this category, in addition to reducing the total peripheral vascular resistance (TPVR), a decline in cardiac output also plays a role. Risk factors for anesthesia-induced hypotension are the followings: (chronic alcohol consumption, history of hypertension, sensory block upper than Th6, and urgency of surgery). To prevent SA-induced hypotension it is advisable to reduce the doses of local anesthetics. Data from the most studies do not confirm the effectiveness of extended infusion therapy in the prevention and correction of hypotension. Vasopressors - phenylephrine in obstetric practice, ephedrine or dopamine in elderly patients are effective for preventing hypotension.

Keywords: spinal anesthesia, subarachnoid block, hypotension, phenylephrine, ephedrine, dopamine
p. 101-115 of the original issue
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Address for correspondence:
119991, Russian Federation,
Moscow, Trubetskaya Str., 8-2,
Sechenov First Moscow
State Medical University (Sechenov University),
the Department of Anesthesiology
and Reanimatology,
Sklifosovsky Institute of Clinical Medicine
tel.: +7 (916) 143-96-21,
e-mail: ovechkin_alexei@mail.ru
Ovechkin Àlexei M.
Information about the authors:
Ovechkin Àlexei M., MD, Professor of the Department of Anesthesiology and Reanimatology, Sechenov First Moscow State Medical University (Sechenov University) of the Ministry of Health of Russia, Moscow, Russian Federation.
https://orcid.org/0000-0002-3453-8699
Sokologorskiy Sergei V., MD, Professor of the Department of Anesthesiology and Reanimatology, Sechenov First Moscow State Medical University (Sechenov University) of the Ministry of Health of Russia, Moscow, Russian Federation.
https://orcid.org/0000-0001-6805-9744
Politov Mikhail E., PhD, Associate Professor of the Department of Anesthesiology and Reanimatology, Sechenov First Moscow State Medical University (Sechenov University) of the Ministry of Health of Russia, Moscow, Russian Federation.
https://orcid.org/0000-0003-0623-4927
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