Vücut Yuvarlaklık İndeksinin Spinal Anestezi Blok Karakteristik Özellikleri Üzerine Etkileri

Öz

Vücut yuvarlaklık indeksi (BRI), insan vücut şeklinin boy ve bel çevresini birleştiren bir elips olduğu varsayımına dayanır. Bu çalışmada, elektif cerrahi geçiren hastalarda BRI'nın spinal anestezi [SA] duyu seviyeleri ve hipotansiyon üzerine etkisini araştırmayı amaçladık. Bu gözlemsel çalışmada, transüretral ve alt ekstremite cerrahisi için L3-L4 intervertebral boşluktan, 15 mg %0.5 hiperbarik bupivakain kullanılarak, tek seferde spinal anestezi uygulanan, ASA fiziksel durumu I-III olan 18-80 yaşındaki hastalar prospektif olarak kaydedildi. On beş ve 30. dakikalarda maksimum duyusal blokaj seviyesi, bloğun L2 seviyesine gerileme süresi, hipotansiyon, bradikardi oluşumu kaydedildi. BRI, bel ve kalça çevresi parametreleri 15. dakikada maksimum duyusal blokaj düzeyi için bağımsız predikte edici faktörler olarak bulundu [OR=65.7 %95 GA: 1.304-3310, p=0.036; OR=0.733 %95 CI: 0.558-0.963, p=0.026; OR=1.065 %95 CI: 1.001-1.133, p=0.047; sırasıyla]. SA sonrası hipotansiyon gelişmesi ile antropometrik değişkenlerle ilişkili bulunmadı. BRI, SA uygulanan hastalarda lokal anesteziklerin artan sefalik yayılımını öngörmek için yeni bir pratik araç olarak kullanılabilir.

Anahtar Kelimeler

• Spinal anestezi
• vücut yuvarlaklık indeksi
• hipotansiyon
• obezite
• sefalik yayılım

Effects of Body Roundness Index on Spinal Anesthesia Block Characteristics

Öz

Body roundness index (BRI) is based on the assumption that the human body's shape is an ellipse, which combines height and waist circumference. We aimed to investigate the effect of BRI on spinal anesthesia [SA] sensory levels and hypotension in patients undergoing elective surgery. In this observational study, we prospectively enrolled 18-80 years old patients with ASA physical status I-III who underwent single-shot spinal anesthesia using 15 mg 0.5% hyperbaric bupivacaine at L3–L4 intervertebral space for transurethral and lower limb surgery. Maximum sensory blockade level at 15th and 30th min, block regression time to L2 level, hypotension, bradycardia occurrence were recorded. BRI, waist, and hip circumference were found as independent predictive factors in a maximum sensory blockade level at 15th min [OR=65.7 95% CI: 1.304-3310, p=0.036; OR=0.733 95% CI: 0.558-0.963, p=0.026; OR=1.065 95% CI: 1.001-1.133, p=0.047; respectively]. Hypotension after SA was not associated with anthropometric variables. BRI can be used as a new practical tool to predict the increased cephalic spread of local anesthetic in patients undergoing SA.

Anahtar Kelimeler

• Spinal anesthesia
• body roundness index
• hypotension
• obesity
• cephalic spread.

Kaynakça

1. Referans1 Logan MR, McClure JH & Wildsmith JA. (1986). Plain bupivacaine: an unpredictable spinal anaesthetic agent. Br J Anaesth, 58, 292-6.
2. Referans2 Pitkänen MT. (1987). Body mass and spread of spinal anesthesia with bupivacaine. Anesth Analg, 66, 127-31.
3. Referans3 Pitkänen M, Haapaniemi L, Tuominen M & Rosenberg PH. (1984). Influence of age on spinal anaesthesia with isobararic 0.5 % bupivacaine. Br J Anaesth, 56, 279-84.
4. Referans4 McCulloch WJ & Littlewood DG. (1986). Influence of obesity on spinal analgesia with isobaric 0.5 % bupivacaine. Br J Anaesth, 58, 610-4.
5. Referans5 Greene NM. (1985). Distribution of local anesthetic solutions within the subarachnoid space. Anesth Analg, 64, 715-30.
6. Referans6 Stienstra R & Greene NM. (1991). Factors affecting the subarachnoid spread of local anesthetic solutions. Reg Anesth Pain Med, 16, 1-6.
7. Referans7 Liu SS & McDonald SB. (2001). Current issues in spinal anesthesia. Anesthesiology, 94, 888-906.
8. Referans8 Carpenter RL, Hogan QH, Liu SS, Crane B & Moore J. (1998). Lumbosacral cerebrospinal fluid volume is the primary determinant of sensory block extent and duration during spinal anesthesia. Anesthesiology, 89, 24-9.

9. Referans9 Hogan QH, Prost R, Kulier A, Taylor ML, Liu S & Mark L. (1996). Magnetic resonance imaging of cerebrospinal fluid volume and the influence of body habitus and abdominal pressure. Anesthesiology, 84, 1341-9.
10. Referans10 Carvalho B, Collins J, Drover DR, Ralls LA & Riley ET. (2011). ED (50) and ED (95) of intrathecal bupivacaine in morbidly obese patients undergoing cesarean delivery. Anesthesiology, 114, 529-35.
11. Referans11 Thomas DM, Bredlau C, Bosy-Westphal A, Mueller M, Shen W, Gallagher D, Maeda Y, McDougall A, Peterson MC, Ravussin E & Heymsfield SB. (2013). Relationships between body roundness with body fat and visceral adipose tissue emerging from a new geometrical model. Obesity, 21, 2264–71.
12. Referans12 Kozanhan B, Bardak O, Tutar MS, Ozler S, Yildiz M & Solak I. (2020).The influence of Body Roundness Index on sensorial block level of spinal anaesthesia for elective caesarean section: an observational study. J Obstet Gynaecol, 40, 772-8.
13. Referans13 Patel AV, Hildebrand JS & Gapstur SM. (2014). Body mass index and all-cause mortality in a large prospective cohort of white and black U.S. Adults. PLoS One, 9, e109153.
14. Referans14 Rico‐Martín S, Calderón‐García JF., Rey PS, Antonio CF, Alvarez MM & Juan F. Sánchez Muñoz‐Torrero. (2020). Effectiveness of body roundness index in predicting metabolic syndrome: A systematic review and meta‐analysis, Obes Rev, 21, e13023.
15. Referans15 Chang Y, Guo X, Chen Y, Guo L, Li Z, Yu S, Yang H & Sun Y. (2015). A body shape index and body roundness index: two new body indices to identify diabetes mellitus among rural populations in northeast China. BMC Public health, 15, 794.
16. Referans16 Taivainen T, Tuominen M & Rosenberg PH. (1990). Influence of obesity on the spread of spinal analgesia after injection of plain 0.5% bupivacaine at the L3-4 or L4-5 interspace. Br J Anaesth, 64, 542-6.
17. Referans17 Robinson LS. (1949). The collateral circulation following ligation of the inferior vena cava; injection studies instillborn infants. Surgery, 25, 329-47.
18. Referans18 Barclay DL, Renegar OJ & Nelson EW Jr. (1968). The influence of inferior vena cava compression on the level of spinal anesthesia. Am J Obstet Gynecol, 101, 792-800.
19. Referans19 Solak I, Guney I, Cihan FG, Mercan S & Eryilmaz MA. (2018). Evaluation of a body shape index and body roundness index, two new anthropometric indices, in obese individuals. Acta Medica, 34, 1545-50.