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CONTINUOUS SPINAL ANESTHESIA VERSUS COMBINED SPINAL-EPIDURAL ANESTHESIA FOR INFRAINGUINAL REVASCULARIZATION IN ELDERLY HIGH-RISK PATIENTS
ESRA Academy. Arabadzhieva D. Sep 8, 2016; 138551; 0419 Topic: Spinal Anaesthesia - Analgesia
Dr. Daniela Arabadzhieva
Dr. Daniela Arabadzhieva

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Abstract
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Background and Aims:

To compare the effects of continuous spinal anesthesia (CSA) and combined spinal-epidural technique (CSE) on hemodynamics for patients with peripheral artery disease (PAD) undergoing lower limb revascularization.

Methods:

We conducted a retrospective analysis of the records of 66 patients who received CSA and 52 patients received CSE in the period January 2014 - December 2015 for infrainguinal vascular surgery. The “catheter over needle” (Spinocath, B.Braun) technique was performed for CSA and “needle-through-needle” technique was performed for CSE. 0.5% Bupivacaine was used as a local anesthetic in all patients. The demographic data of patients, induction and total dose of anesthetic, the volume of intraoperative infusion, the frequency of hypotension and  bradycardia were investigated.

Results:

There are no statistically significant differences between the demographic characteristics of both groups of patients and the type and duration of operations. In the CSA group the first dose of local anesthetic, the frequency of hemodynamic complications and the volume of intraoperative infusion, required to maintain stable hemodynamics are significantly lower than those in the CSEA group. There is no significant difference in total dose of local anesthetic.

Conclusions:

Continuous spinal anesthesia limits the sympathetic blockade by titrating the dose of the local anesthetic and gives opportunity to provide a stable intraoperative hemodynamics. CSA allows limiting the volume of infusions and this is advantage, because of limited functional reserve of patients with PAD. СSA is good alternative for CSE and should be the technique of choice for revascularization procedures of the lower limb.







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