MECHANISMS OF HEMODYNAMIC INSTABILITY DURING SPINAL-EPIDURAL ANESTHESIA IN ELDERLY PATIENTS UNDERGOING TRANSURETHRAL RESECTION OF THE PROSTATE

Introduction. Most patients undergoing transurethral resection of the prostate (TURP) are elderly, and com­bined spinal-epidural anesthesia (CSEA) in this population is frequently complicated by hemodynamic instability due to sympathetic blockade. Aim: to assess the dynamics of systemic and central hemodynamics, the structure of com­plications and their association with hemodynamic parameters in elderly patients undergoing TURP under CSEA. Materials and methods. Eighty patients aged 60 years and older were studied at the clinic of Andijan State Medical Institute: a control group (n=41, 2021-2022, retrospective) and a comparison group (n=39, 2023, prospective, ex­tended monitoring). Systolic, diastolic and mean arterial pressure, heart rate, rate-pressure product, Kerdo index, cardiac index and systemic vascular resistance were recorded at 19 time points during the pre-, intra- and early postoperative periods. Results. The maximum decrease occurred 10-20 minutes after the block: mean arterial pressure fell by 19.3%, cardiac index by 32.3% and systemic vascular resistance by 23.2%. In the control group, 185 complication episodes were recorded; intraoperative hypotension occurred in 41.5% and bradycardia in 22.0% of patients. The decrease in mean arterial pressure correlated most strongly with hypotension (r=-0.781), cerebral (r=-0.655) and renal (r=-0.603) hypoperfusion. Conclusion. Hemodynamic instability during CSEA develops as a sequential cascade of vasodilation, reduced cardiac index and parasympathetic predominance; the individual variability of responses justifies stratifying patients by hemodynamic phenotype.