Differences in hemodynamic parameters in general and spinal anesthesia during lower limb orthopedic surgeries

Introduction. Hemodynamic instability is ? frequent adverse effect during anesthesia and one of the significant parameters in determining the type of anesthesia. This study examined the incidence of hypotension and bradycardia during general and spinal anesthesia in hip and knee arthroplasty, alongside potential causes. We hypothesized that hypotension occurs more frequently with general anesthesia, while bradycardia is more prevalent with spinal anesthesia. Material and Methods. This retrospective study included patients who underwent total hip or knee alloarthroplasty. Data regarding blood pressure, heart rate, long-term antihypertensive therapy, and comorbidities were extracted from medical records. Patients were divided into two groups based on the type of anesthesia administered: general or spinal anesthesia. Results. Among 371 patients, 105 experienced bradycardia, and 308 developed hypotension based on systolic blood pressure measurements. Hypotension was significantly more common in patients receiving general anesthesia, with the lowest mean arterial blood pressure observed in 41 patients (59.4%). However, there was no significant difference in the incidence of bradycardia between spinal and general anesthesia. Similarly, no significant differences were identified in the incidence of hypotension and bradycardia between standard or unilateral spinal anesthesia. Chronic essential hypertension was associated with occurrence higher incidence of bradycardia (86.7%). Additionally, antihypertensive therapy was linked to increased occurrences of both hypotension (134 patients, 43.5%) and bradycardia (74 patients, 70.5%). Discussion/Conclusion. Intraoperative hypotension is more prevalent in patients undergoing general anesthesia. However, no significant difference in the occurrence of bradycardia was observed between general and spinal anesthesia. Essential hypertension and long-term antihypertensive therapy are potential risk factors for bradycardia and hypotension during anesthesia.