The site of the Media Sphera Publishers contains materials intended solely for healthcare professionals.
By closing this message, you confirm that you are a certified medical professional or a student of a medical educational institution.

Login
EN
+7 (495) 482-4118
+7 (495) 482-0604
+8 800 250-18-12
  • (toll-free number for subscriptions)
    Mon-Fri from 10 a.m. to 6 p.m.

  • © 1998-2025
+7 (495) 482-43-29
EN
All journals
Journal
Year
Year
Search result: 0

Neymark M.I.

Altai State Medical University

Burenkin A.A.

Altai State Medical University

Khorev N.G.

Altai State Medical University

Elchaninova S.A.

Altai State Medical University

Nikolaeva M.G.

Altai State Medical University

Neuraxial anesthesia in emergency vascular surgery in elderly and senile patients

Authors:

Neymark M.I., Burenkin A.A., Khorev N.G., Elchaninova S.A., Nikolaeva M.G.

More about the authors

Journal: Russian Journal of Anesthesiology and Reanimatology. 2024;(4): 66‑74

DOI: 10.17116/anaesthesiology202404166

Read: 1054 times

Download PDF (RU)
Contact the author
Table of contents

NEURAXIAL ANESTHESIA IN EMERGENCY VASCULAR SURGERY IN ELDERLY AND SENILE PATIENTS
NEURAXIAL ANESTHESIA IN EMERGENCY VASCULAR SURGERY IN ELDERLY AND SENILE PATIENTS

To cite this article:

Neymark MI, Burenkin AA, Khorev NG, Elchaninova SA, Nikolaeva MG. Neuraxial anesthesia in emergency vascular surgery in elderly and senile patients. Russian Journal of Anesthesiology and Reanimatology. 2024;(4):66‑74. (In Russ.)
https://doi.org/10.17116/anaesthesiology202404166

МСФ на ЯМ
Использование инфографики авторами научных работ
Close metadata
Recommended articles:
Comparison of spinal and gene­ral anesthesia in combination with addu­ctor canal block and local infi­ltration anesthesia in arthroscopic cruciate liga­ment surgery: a randomized controlled trial. Russian Journal of Anesthesiology and Reanimatology. 2025;(5):49-57
Thro­mboembolic complications in the postpartum period. Russian Bulletin of Obstetrician-Gynecologist. 2025;(4):102-107
Resu­lts of the implementation of repe­rfusion technologies in ischemic stroke. S.S. Korsakov Journal of Neurology and Psychiatry. 2025;(8-2):32-39
Abstract:

BACKGROUND

Acute occlusion of lower limb arteries is one of the most common indications for emergency vascular surgery in elderly and senile patients. Neuroaxial anesthesia is common for these procedures. The main disadvantage of traditional spinal anesthesia is hypotension, and methods of its correction (infusion therapy and vasopressors) are not always acceptable in elderly patients. At the same time, perioperative normotension is the best option to prevent acute kidney and myocardial damage.

OBJECTIVE

To justify the feasibility of unilateral spinal anesthesia (ULSA) in elderly patients with acute arterial ischemia of the lower extremities.

MATERIAL AND METHODS

The study included 2 groups of patients by 52 people who underwent surgical treatment: group 1 — bilateral spinal anesthesia (BLSA), group 2 — ULSA. We used a 0.5% solution of Bupivacaine Spinal Heavy in all cases. Effectiveness of motor block was assessed using the Bromage scale. We estimated hemodynamic parameters (blood pressure, heart rate, stroke index, peripheral vascular resistance index) using rheography. Laboratory monitoring included markers of renal damage (creatinine, urea, lipocalin, cystatin C) and myocardial damage (troponin I, MB-kinase, myoglobin).

RESULTS

Unilateral technique provides more stable central hemodynamic parameters compared to traditional spinal anesthesia and no need for vasopressors. Unilateral blockade was followed by positive dynamics in indicators of renal damage and lower markers of myocardial damage compared to bilateral blockade.

CONCLUSION

ULSA may be preferable for urgent vascular surgery in elderly patients.

Keywords:

spinal anesthesia
unilateral spinal anesthesia
central hemodynamics
thrombectomy
embolectomy

Authors:

Neymark M.I.

Altai State Medical University

Burenkin A.A.

Altai State Medical University

Khorev N.G.

Altai State Medical University

Elchaninova S.A.

Altai State Medical University

Nikolaeva M.G.

Altai State Medical University

Received:

13.02.2024

Accepted:

22.03.2024

Close metadata

References:

  1. Earnshaw JJ. Where we have come from: a short history of surgery for acute limb ischaemia. European Journal of Vascular and Endovascular Surgery. 2020;59(2):169-170.  https://doi.org/10.1016/j.ejvs.2019.07.032
  2. Beard J, Gaines P, Earnshaw J. Management of acute lower limb ischaemia. Vascular and Endovascular Surgery. 2009;8:129-146.  https://doi.org/10.5758/vsi.2019.35.1.4
  3. Grip O, Wanhainen A, Michaëlsson K, Lindhagen L, Björck M. Open or endovascular revascularization in the treatment of acute lower limb ischaemia. British Journal of Surgery. 2018;105(12):1598-1606. https://doi.org/10.1002/bjs.10954
  4. Khorev NG, Beller AV, Chichvarov AA. Dynamics of the structure of acute arterial and venous diseases over the past 20 years. Ateroskleroz. 2021;17(3):44-45. (In Russ.). https://doi.org/10.52727/2078-256x-2021-17-3-44-45
  5. Aboyans V, Ricco JB, Bartelink MEL, Björck M, Brodmann M, Cohnert T, Collet JP, Czerny M, De Carlo M, Debus S, Espinola-Klein C, Kahan T, Kownator S, Mazzolai L, Naylor AR, Roffi M, Röther J, Sprynger M, Tendera M, Tepe G, Venermo M, Vlachopoulos C, Desormais I; ESC Scientific Document Group. 2017 ESC Guidelines on the diagnosis and treatment of peripheral arterial diseases, in collaboration with the European society for vascular surgery (ESVS). European Heart Journal. 2018;39(9):763-816.  https://doi.org/10.1093/eurheartj/ehx095
  6. Staerk L, Sherer JA, Ko D, Benjamin EJ, Helm RH. Atrial Fibrillation: Epidemiology, Pathophysiology, and Clinical Outcomes. Circulation Research. 2017;120(9):1501-1517. https://doi.org/10.1161/CIRCRESAHA.117.309732
  7. Lau DH, Nattel S, Kalman JM, Sanders P. Modifiable Risk Factors and Atrial Fibrillation. Circulation. 2017;136(6):583-596.  https://doi.org/10.1161/CIRCULATIONAHA.116.023163
  8. Zabolotskikh IB, Gorobets ES, Grigoryev EV, Kotovskaya YV, Lebedinskii KM, Musaeva TS, Mkhitaryan EA, Ovechkin AM, Ostapenko VS, Rozanov AV, Runikhina NK, Tkacheva ON, Trembach NV, Khoronenko VE, Cherdak MA. Perioperative management of elderly and senile patients. Annals of Critical Care. 2022;(3):7-26. (In Russ.). https://doi.org/10.21320/1818-474X-2022-3-7-26
  9. Altin SE, Kim YG, Aronow HD, Armstrong EJ, Goldsweig AM, Dardik A, Lanksy AJ, Mena-Hurtado CI, Abbott JD. Seasonal variation in U.S. hospitalizations for chronic limb-threatening ischemia. Catheterization and Cardiovascular Interventions. 2020;96(7):1473-1480. https://doi.org/10.1002/ccd.29261
  10. Ilonzo N, Koleilat I, Prakash V, Charitable J, Garg K, Han D, Faries P, Phair J. The Effect of COVID-19 on Training and Case Volume of Vascular Surgery Trainees. Vascular and Endovascular Surgery. 2021;55(5):429-433.  https://doi.org/10.1177/1538574420985775
  11. Hines GL, Liu HH. Acute Aortic Occlusion and Its Sequelae: Metabolic, Pathologic Etiology, and Management. Cardiology in Review. 2021;29(2):57-61.  https://doi.org/10.1097/CRD.0000000000000313
  12. Glushkov NI, Melnikov MV, Sotnikov AV, Melnikov VM, Gorbunov GN. Peripheral artery embolism in patients with diabetes mellitus: surgical treatment, complications, outcomes. Vestnik Severo-Zapadnogo gosudarstvennogo meditsinskogo universiteta im. I.I. Mechnikova. 2016;8(4):38-43. (In Russ.).
  13. Melnikov MV, Apresyan AYu. Continuity of medical care to patients as a measure to prevent complications in the treatment of peripheral artery embolism. Russian Journal of Preventive Medicine. 2023;26(12):27-33. (In Russ.). https://doi.org/10.17116/profmed20232612127
  14. Fahad AM, Al Khalidi HA, Altimimi YQM. Surgical thrombectomy versus conservative treatment in cases of acute limb ischemia with COVID 19 pneumonia. Cardiovascular Therapy and Prevention. 2021;20(4):2885. https://doi.org/10.15829/1728-8800-2021-2885
  15. Pasko VG, Kutepov DE, Gavrilov SV, et al. Analysis of the effectiveness of treatment of patients with new coronavirus infection COVID-19. Lechenie i profilaktika. 2020;10(3):5-10. (In Russ.).
  16. Caspary L, Creutzig A, Alexander K. Orthostatic vasoconstrictor response in patients with occlusive arterial disease assessed by laser Doppler flux and transcutaneous oximetry. Angiology. 1996;47(2):165-170.  https://doi.org/10.1177/000331979604700208
  17. Pokrovskij AV, Dan VN, Chupin AV, Xarazov AF. Khirurgicheskoe lechenie bol’nykh s kriticheskoj ishemiej nizhnikh konechnostej. Kriticheskaya ishemiya. Itogi XX veka. Materialy III Mezhdunarodnogo kongressa severnykh stran i regionov. Petrozavodsk — Parizh; 1999:120. (In Russ.).
  18. Gavrilenko AV, Skrylev SI, Kuzubova EA. Opyt khirurgicheskogo lecheniya bol’nykh s kriticheskoj ishemiej nizhnikh konechnostej. Vos’moj Vserossijskij s”ezd serdechno-sosudistykh khirurgov. M. 2002:119. (In Russ.).
  19. Klinicheskie rekomendatsii. Ostraya ishemiya nizhnikh konechnostej. 2022. (In Russ.). Accessed May 20, 2024. https://www.angiolsurgery.org/library/recommendations/2022/ischaemia/recommendation.pdf
  20. Koryachkin VA. Nejroaksial’nye blokady. SPb: ELBI; 2013. (In Russ.).
  21. Rathmell JP, Neal JM, Viscomi CM. Regional Anesthesia. The Requisites in Anesthesiology. 3rd edn. Zilber AP, Maltsev VV, eds. M.: MEDpress-inform; 2013. (In Russ.).
  22. Ovechkin AM, Sokologorsky SV, Politov ME. Spinal anesthesia and hypotension: mechanisms, risk factors, preventive and corrective measures. Novosti khirurgii. 2021;29(1):101-115. (In Russ.). https://doi.org/10.18484/2305-0047.2021.1.101
  23. Kalogeris T, Baines CP, Krenz M, Korthuis RJ. Cell biology of ischemia/ reperfusion injury. International Review of Cell and Molecular Biology. 2012; 298:229-317.  https://doi.org/10.1016/B978-0-12-394309-5.00006-7
  24. Calvo-Vecino JM, Ripollés-Melchor J, Mythen MG, Casans-Francés R, Balik A, Artacho JP, Martínez-Hurtado E, Serrano Romero A, Fernández Pérez C, Asuero de Lis S; FEDORA Trial Investigators Group. Effect of goal-directed haemodynamic therapy on postoperative complications in low-moderate risk surgical patients: a multicentre randomised controlled trial (FEDORA trial). British Journal of Anesthesia. 2018 Apr;120(4):734-744.  https://doi.org/10.1016/j.bja.2017.12.018
  25. Messina A, Robba C, Calabrò L, Zambelli D, Iannuzzi F, Molinari E, Scarano S, Battaglini D, Baggiani M, De Mattei G, Saderi L, Sotgiu G, Pelosi P, Cecconi M. Association between perioperative fluid administration and postoperative outcomes: a 20-year systematic review and a meta-analysis of randomized goal-directed trials in major visceral/noncardiac surgery. Critical Care. 2021;25:43.  https://doi.org/10.1186/s13054-021-03464-1
  26. Yeager MP, Spence BC. Perioperative Fluid Management: Current Consensus and Controversies. Seminars in Dialysis. 2006;19(6):472-479.  https://doi.org/10.1111/j.1525-139X.2006.00209.x
  27. Leonova EA, Moroz GB, Shmyrev VA, Lomivorotov VV. Intraoperative hypotension. Annals of Critical Care. 2018;3:87-96. (In Russ.). https://doi.org/10.21320/1818-474X-2018-3-87-96
  28. Casati A, Coppelleri G, Fanelli G. Unilateral spinal anesthesia: fact or fiction. Regional Anesthesia. 1997;22(6):594-595. 
  29. Moosavi Tekye SM, Alipour M. Comparison of the effects and complications of unilateral spinal anesthesia versus standard spinal anesthesia in lower-limb orthopedic surgery. Brazilian Journal of Anesthesiology. 2014;64(3):173-176.  https://doi.org/10.1016/j.bjane.2013.06.014
  30. Tsygankov KA, Korepanov AN, Lakhin RE, Shchegolev AV, Khalikov AD, Matic AI. Comparison of hemodynamic parameters in patients with transurethral resection of the bladder during spinal anesthesia using levobupivacaine and ropivacaine. Regionarnaya anesteziya i lechenie ostroj boli. 2018;12(4):250-256. (In Russ.). https://doi.org/10.17816/1993-6508-2018-12-4-250-256
  31. POISE Study Group; Devereaux PJ, Yang H, Yusuf S, Guyatt G, Leslie K, Villar JC, Xavier D, Chrolavicius S, Greenspan L, Pogue J, Pais P, Liu L, Xu S, Málaga G, Avezum A, Chan M, Montori VM, Jacka M, Choi P. Effects of xtendedrelease metoprolol succinate in patients undergoing non-cardiac surgery (POISE trial): a randomised controlled trial. Lancet. 2008;371(9627):1839-1847. https://doi.org/10.1016/S0140-6736(08)60601-7
  32. Rosenman DJ, McDonald FS, Ebbert JO, Erwin PJ, LaBella M, Montori VM. Clinical consequences of withholding vs. administering renin-angiotensin-aldosterone system antagonists in the pre-operative period. Journal of Hospital Medicine. 2008;3(4):319-325.  https://doi.org/10.1002/jhm.323
  33. Kristensen SD, Knuuti J, Saraste A, Anker S, Bøtker HE, Hert SD, Ford I, Gonzalez-Juanatey JR, Gorenek B, Heyndrickx GR, Hoeft A, Huber K, Iung B, Kjeldsen KP, Longrois D, Lüscher TF, Pierard L, Pocock S, Price S, Roffi M, Sirnes PA, Sousa-Uva M, Voudris V, Funck-Brentano C; Authors/Task Force Members. Task Force Members. 2014 ESC/ESA Guidelines on non-cardiac surgery: cardiovascular assessment and management: The Joint Task Force on non-cardiac surgery: cardiovascular assessment and management of the European Society of Cardiology (ESC) and the European Society of Anaesthesiology (ESA). European Heart Journal. 2014;35(35):2383-2431. https://doi.org/10.1093/eurheartj/ehu282
  34. Salinas FV, Sueda LA, Liu SS. Physiology of spinal anaesthesia and practical suggestions for successful spinal anaesthesia. Best Practice and Research. Clinical Anaesthesiology. 2003;17(3):289-303.  https://doi.org/10.1016/s1521-6896(02)00114-3
  35. Bykov AS, Repin KYu, Davydova NS. Autoregulation of systemic hemodynamics under various types of anesthesia. Ural’skij meditsinskij zhurnal. 2007;6:64-70. (In Russ.).
  36. Korneev SV. The use of unilateral spinal anesthesia during operations on the lower extremities in traumatology. Vestnik khirurgii Kazakhstana. 2011;3(27):36-37. (In Russ.).
  37. Vinogradov SV, Gnetetskaya KI. Otsenka gemodinamiki vo vremya monolateral’noj spinal’noj anestezii u gerontologichskikh patsientov pri odnoplyusnom protezirovanii tazobedrennogo sustava. Aktual’nye problemy meditsiny. Sbornik materialov itogovoj nauchno-prakticheskoj konferentsii. Otv. redaktor V.A. Snezhitskij. Grodno: Izdatel’stvo Grodnenskogo gosudarstvennogo meditsinskogo universiteta; 2020:116-118. (In Russ.).
  38. Filimonov RV, Gritsenko SN, Filimonova IV, Kobelyatsky YuYu. Comparative analysis of monolateral and bilateral spinal anesthesia. Regionarnaya anesteziya i lechenie ostroj boli. 2021;15(4):237-244. (In Russ.). https://doi.org/10.17816/1993-6508-2021-15-4-237-244
  39. Casati A, Fanelli G. Unilateral spinal anesthesia. State of the Art. Minerva Anestesiologica. 2001;67(12):855-862. 
  40. Soatov AR, Semenikhin AA. Ways to reduce surgical and anesthetic risk during operations on the lower extremities in geriatric patients with circulatory failure. Regionarnaya anesteziya i lechenie ostroj boli. 2013;7(1):33-37. (In Russ.).
  41. Lakhin RE, Safin RR, Shchegolev AV, Bogomolov BN, Moroz EN. Comparison of different methods of selective and traditional spinal anesthesia for total knee arthroplasty. Messenger of Anesthesiology and Resuscitation. 2012;9(4):12-16. (In Russ.).
  42. Wei C, Qian J, Zhang Y, Chang X, Hu H, Xiao F. Prospective, randomised, double-blind, dose-finding study of norepinephrine for preventing spinal-induced hypotension during caesarean delivery under combined spinal-epidural anaesthesia. European Journal of Anesthesiology. 2020;37(4):309-315.  https://doi.org/10.1097/EJA.0000000000001152
  43. Fu F, Xiao F, Chen W, Yang M, Zhou Y, Ngan Kee WD, Chen X. A randomised double-blind dose-response study of weight-adjusted infusions of norepinephrine for preventing hypotension during combined spinal-epidural anaesthesia for Caesarean delivery. British Journal of Anaesthesia. 2020;124:108-114.  https://doi.org/10.1016/j.bja.2019.12.019
  44. Jackson R, Reid JA, Thorburn J. Volume preloading is not essential to prevent spinal-induced hypotension at caesarean section. British Journal of Anaesthesia. 1995;75(3):262-65.  https://doi.org/10.1093/bja/75.3.262
  45. Shifman EM, Filippovich GV, Antipin DP, Bukin VE, Vainshtein BD, Geronimus VYu, Zhemchugov AV, Zarubina IE, Kalini AL, Katsman AB, Katsman OB, Maslak VN, Moshensky VN, Nomokonov GG, Smirnov IV, Terentyev NV. The influence of neuraxial block on changes in hemodynamics in women in labor. General Reanimatology. 2006;2(2):20-23. (In Russ.). https://doi.org/10.15360/1813-9779-2006-2-20-23
Contact the author
Email
Message
The publishing house "Media Sphere" does not provide treatment services, does not give recommendations on contacting medical institutions and specific specialists, on the prescription of medicines and dietary supplements.

Email Confirmation

An email was sent to test@gmail.com with a confirmation link. Follow the link from the letter to complete the registration on the site.

Email Confirmation

Contact us
If you have any questions, complaints or suggestions, please use this feedback form.
Email
Message
The publishing house "Media Sphere" does not provide treatment services, does not give recommendations on contacting medical institutions and specific specialists, on the prescription of medicines and dietary supplements.
Submit Application

You can become an author of one of our magazines, send a request and we will consider it in during the day.

Name
Phone
E-mail
Message
Login
Registration
E-mail
Password
Forgot Password?

Log in to the site using your account in one of the services

Password recovery
E-mail
Login
Register

We use cооkies to improve the performance of the site. By staying on our site, you agree to the terms of use of cооkies. To view our Privacy and Cookie Policy, please. click here.