Neuraxial anesthesia in emergency vascular surgery in elderly and senile patients

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.