The effect of three kinds of reverse trendelenburg position angle in block plane of prone position after subarachnoid anesthesia
10.3760/cma.j.jssn.1673-4904.2016.06.014
- VernacularTitle:三种头高位角度对蛛网膜下隙麻醉后俯卧位阻滞平面的影响
- Author:
Xinqiang JIN
;
Kunlian QIAN
;
Changling TANG
;
Lihua HUANG
- Publication Type:Journal Article
- Keywords:
Prone position;
Block plane;
Subarachnoid space anesthesia;
Procedure for prolapse and hemorrhoids;
Ropivacaine
- From:
Chinese Journal of Postgraduates of Medicine
2016;39(6):525-528
- CountryChina
- Language:Chinese
-
Abstract:
Objective To compare the effect of three kinds of reverse trendelenburg position angle in block plane of prone position after subarachnoid anesthesia, in order to acquire the conformable reverse trendelenburg position angle of prolapse and hemorrhoids (PPH). Methods Sixty patients having underwent the selective PPH were divided into 10° group, 20° group and 30° group by random digits table method with 20 cases each. Subarachnoid puncture was performed in the L3 - 4 processus spinosus gap, then 0.5%heavy density ropivacaine 2 ml was injected. After anesthesia, the operation bed was adjusted to reverse trendelenburg position 10° (10° group), 20° (20° group) and 30° (30° group). At the same time the patients changed to prone position, and the operation bed was changed to horizontal position before operation. The patients changed to jackknife position 10 min after drug injection of subarachnoid anesthesia. The sensory blockade after drug infusion, circulation function change, anesthetic effect and perioperative adverse reaction were observed. Results There were no statistical differences in operation start time and fixed time of anesthesia plane among 3 groups (P>0.05). The upper bound of sensory nerve block before horizontal position, upper bound of sensory nerve block before jackknife position, highest plane of sensory nerve block in 10° group were significantly higher than those in 20° group and 30° group: T(10.47 ± 0.65) vs. T(12.36 ± 0.72) and T(12.50 ± 0.54), T(10.12 ± 0.56) vs. T(11.82 ± 0.66) and T(11.99 ± 0.72), T(9.53 ± 0.71) vs. T(11.32 ± 0.78) and T(11.54 ± 0.83), and there were statistical differences (P<0.05); but there were no statistical difference between 20° group and 30° group (P>0.05). The systolic blood pressure and diastolic blood pressure levels 15 and 20 min after drug infusion in 10° group were significantly lower than those in 20° group and 30° group, systolic blood pressure:(120.40 ± 7.38) mmHg (1 mmHg=0.133 kPa) vs. (131.82 ± 7.88) and (130.47 ± 7.57) mmHg, (119.55 ± 7.65) mmHg vs. (131.25 ± 9.67) and (130.23 ± 8.69) mmHg, diastolic blood pressure: (63.74 ± 6.54) mmHg vs. (71.36 ± 8.49) and (74.32 ± 7.54) mmHg, (61.59 ± 6.23) mmHg vs. (72.98 ± 7.39) and (73.75 ± 6.34) mmHg, and there were statistical differences (P<0.05);but there were no statistical difference between 20° group and 30° group (P>0.05). No patients′ anesthesia effect was poor in 3 groups, but 4 cases in 30° group were good. Hypotension and tachycardia occurred in 2 cases in 10° group, respectively. Conclusions Immediately prone position after subarachnoid anesthesia can be adjusted by reverse trendelenburg position angle to get the appropriate level of anesthesia, and conformable reverse trendelenburg position angle of PPH is 20°.
