The Effect of Anesthesia Method on Hemodynamics during Abdominal Hysterectomy: A Comparative Analysis

Background: Hemodynamic stability during surgery is critical for preventing perioperative complications.The choice of anesthesia (general vs. spinal) significantly impacts hemodynamic parameters due to differences in physiological mechanisms, including the effects of anesthetics, analgesics, or sympathetic nervous system blockade.However, the influence of various anesthesia techniques, including low-opioid general anesthesia, on hemodynamics during abdominal hysterectomy remains insufficiently studied.Methodology: This study analyzed data from 118 women (aged 35-65 years) divided into three groups: multimodal low-opioid general anesthesia (MMA, n = 47), spinal anesthesia with hyperbaric bupivacaine (SA, n = 33), and adjuvant spinal anesthesia (ASA, n = 38).Hemodynamic parameters (blood pressure, heart rate, stroke volume, systemic vascular resistance) were evaluated at seven stages: preoperatively, pre-induction, post-induction, during the traumatic phase of surgery, and 1, 3, and 6 hours postoperatively. Results:The SA and ASA groups demonstrated a 23-28% reduction in systolic and diastolic blood pressure compared to MMA (p < 0.001), with a 33-fold lower risk of hypertension (OR = 33.0).However, the ASA group exhibited significant bradycardia (heart rate decreased by 27-32%), requiring atropine correction in 23.6% of cases.Central hemodynamic analysis revealed lower stroke volume (SV) and systemic vascular resistance (SVR) in the SA and ASA groups due to sympathetic blockade.Partial recovery of SV (+9.38%) and SVR (+28.02%) in ASA was attributed to dexmedetomidine's alpha-adrenergic effects.Hemodynamic parameters normalized in all groups 6 hours postoperatively. Conclusion:Spinal anesthesia, particularly with adjuvants, ensures more stable hemodynamics compared to MMA, reducing intraoperative complications (e.g., myocardial ischemia) and enhancing patient safety, especially in high-risk cardiovascular patients.