Left Ventricular End-Diastolic Pressure response to spinal anaesthesia in euvolaemic vascular surgery patients

Background: Regional anaesthesia techniques provide highly effective alternatives to general anaesthesia. Existing evidence of the effect of spinal anaesthesia (SA) on cardiac diastolic function is scarce. This study aimed to evaluate the effects of a single-injection, low-dose SA on left ventricular (LV) end-diastolic pressures (LVEDP) using echocardiography in euvolaemic patients undergoing elective vascular surgery. Methods: This is a prospective study in adult patients undergoing elective vascular surgery with SA. Patients with contraindications for SA or significant valvular disease were excluded. During patients’ evaluations fluid administration was targeted using arterial waveform monitoring. All patients underwent echocardiographic studies before and after SA for the assessment of indices reflective of diastolic function. LVEDP was evaluated using E/e’ ratio. Blood samples were drawn to measure troponin and brain natriuretic peptide (BNP) levels before and after SA. Results A total of 62 patients (88.7% males, 71.00 ± 9.42 years) were included in the analysis. In total population, both end-diastolic (EDV, 147.51 ± 41.36 vs 141.72 ± 40.13 ml; p = 0.044) and end-systolic volume (ESV, 69.50 [51.50] vs 65.00 [29.50] ml; p < 0.001) decreased and E/e’ ratio significantly decreased (10.80 [4.21] vs 9.55 [3.91]; p = 0.019). In patients with elevated compared to those with normal LV end-diastolic pressures (LVEDP), an overall improvement in diastolic function was noted. The A increased (-6.58 ± 11.12 vs 6.46 ± 16.10; p < 0.001) and E/A decreased (0.02 ± 0.21 vs -0.36 ± 0.90; p = 0.004) only in the elevated LVEDP group. Patients with elevated LVEDP had a greater decrease in E/e’ compared to those with normal LVEDP (-0.03 ± 2.39 vs -2.27 ± 2.92; p = 0.002). Conclusion This study provides evidence that SA in euvolaemic patients undergoing elective vascular surgery improved LVEDP.