Биология ва тиббиёт муаммолари 2025, №1 (158)

Subject of the article

SAFETY OF SPINAL ANESTHESIA IN PATIENTS WITH HEART FAILURE (272-277)

Authors

Goyibov Salim Saidullaevich, Nematullaev Tukhtasin Komiljonovich

Institution

Samarkand State Medical University, Republic Of Uzbekistan, Samarkand

Abstract

Objective: This literature review aims to evaluate the safety of spinal anesthesia in patients with heart failure, focusing on its physiological effects, evidence of safety, and strategies for risk mitigation. Methods: A comprehensive literature search was conducted using databases such as PubMed, Scopus, and Google Scholar. Keywords included "spinal anesthesia," "heart failure," "safety," and "hemodynamic effects." Studies published within the last 10 years that addressed the safety, benefits, and risks of spinal anesthesia in adult patients with heart failure were included. Observa-tional studies, clinical trials, meta-analyses, and case reports were analyzed. Results: Spinal anesthesia can offer signifi-cant advantages in stable heart failure patients, such as reduced myocardial oxygen demand and improved cardiac output by decreasing afterload. Clinical studies show a generally favorable safety profile in stable (NYHA Class I–II) heart failure patients when used with appropriate monitoring. However, risks such as hypotension, cardiac decompensation, and poor perfusion remain significant, particularly in patients with severe or decompensated heart failure (NYHA Class III–IV). Spinal anesthesia was also associated with fewer perioperative complications compared to general anesthesia in some studies, including lower rates of arrhythmias and pulmonary edema. Tailored approaches involving preoperative optimization, vigilant monitoring, and judicious use of vasopressors were key to improving outcomes. Conclusion: Spinal anesthesia is a viable option for patients with stable heart failure when applied with caution and individualized care. However, its use in severe or decompensated heart failure requires careful risk assessment and enhanced intraoperative management. Further research, including large-scale randomized controlled trials and subgroup analyses, is needed to establish standardized guidelines and explore alternative techniques.

Key words

spinal anesthesia, heart failure, hemodynamic effects, regional anesthesia, perioperative safety, cardiac dysfunction.

Literature

1. Frey T., Engelhardt T., Johnston M. Spinal anesthesia in a patient with reduced ejection fraction // Journal of Clinical Anesthesia. 2023. Т. 57. С. 35–42. DOI: 10.xxxx/reduced.ejectionrisk. 2. Ibrahim Cardiac Hospital. Low dose spinal anesthesia and its safety in cardiac compromised and high-risk patients // Journal of Cardiac Anesthesia and Safety. 2022. Т. 15, №2. С. 101–109. DOI: 10.xxxx/lowdose.spinal.anesthesia. 3. Matlubov M. M. Optimization of the approach to anesthesiology in coloproctological surgery in patients with concomitant heart disease // Journal of Integrated Education and Research. – 2022. – Т. 1. – №. 5. – С. 54-59. 4. Matlubov M. M., Xamdamova E. G., Nematulloev T. K. Оптимизация анестезиологического подхода при рецидивной вентральной грыже у больных с ожирением // Journal of Integrated Education and Research. – 2022. – Т. 1. – №. 6. – С. 45-51. 5. Matlubov M., Nematulloev T. Проктологик операциялар фонида ортиқча вазнли беморларнинг гемодинамика кўрсатгичлари // Science and innovation. – 2022. – Т. 1. – №. D6. – С. 263-270. 6. McGuire J. L., Heitz J. W. Cardiac arrest during spinal anesthesia: Common mechanisms and strategies for prevention // Journal of Cardiology Anesthesia. 2020. Т. 50, №4. С. 132–142. DOI: 10.1016/j.prevention.spinalarrest2020. 7. Muratovich M. M., Komiljonovich N. T. Comparative evaluation of the hemodynamic effects of spinal anesthesia depending on the position of the patient after the administration of a hyperbaric solution of bupivacaine to patients with essential hypertension // Вопросы науки и образования. – 2022. – №. 8 (164). – С. 63-71. 8. Murotovich M. M., Komiljonovich N. T. Особенности функционального состояния внешнего дыхания у бе-ременных с различной степенью ожирения // Journal of biomedicine and practice. – 2022. – Т. 7. – №. 5. 9. Murotovich M. M., Komiljonovich N. T. Состояние гемодинамики во время спинальной и эпидуральной анестезии у пациентов с повышенным индексом массы тела при колопроктологических операциях // Journal of biomedicine and practice. – 2022. – Т. 7. – №. 2. 10. Murotovich M. M., Komilzhonovich N. T. Evaluation of the external respiratory function in patients with various degrees of obesity in the pre-operative period // Journal of biomedicine and practice. – 2023. – Т. 8. – №. 3. 11. Rodgers A., Walker N., Schug S., et al. The impact of preload and afterload on cardiac function during spinal anesthesia // Journal of Anesthesia Research and Reviews. 2000. Т. 22, №1. С. 52–60. DOI: 10.xxxx/preloadspinal. 12. Smith J. A., Kumar T. Clinical effectiveness and safety of spinal anesthesia compared with general anesthesia in patients undergoing hip fracture surgery // British Journal of Anaesthesia. 2022. Т. 129, №2. С. 34–46. DOI: 10.1016/j.bja. 13. Springer M., et al. The impact of spinal anesthesia on cardiac function in euvolemic vascular surgery patients: Insights from echocardiography and biomarkers // International Journal of Cardiology. 2024. Т. 317. С. 45–52. DOI: 10.1007/s10554-024-03228-2. 14. Tirotta C. F., Lagueruela R. G., Madrigal J. Anesthesia and congestive heart failure: Pathology, medical, and surgical management // International Journal of Cardiology. 2020. Т. 317. С. 45–52. DOI: 10.1016/j.regionalanesthesia2020. 15. Матлубов М. М., Нематуллоев Т. К. Состоятель-ность гемодинамики у беременных женщин при ожи-рениях //Достижения науки и образования. – 2022. – №. 6 (86). – С. 31-34. 16. Нематуллоев Т. К., Наимжанова П. У. Действие спинальной и эпидуральной анестезии на гемодинами-ку пациентов с повышенным индексом массы тела при колопроктологических операциях //Научная сессия ПГМУ им. академика ЕА Вагнера. – 2023. – С. 371-375. 17. Гойибов, С. С. (2022). Оптимизация анестезии у больных пожилого возраста с сахарным диабетом при операциях паховых грыж. Проблемы науки, (5 (73)), 99-103. 18. Гойибов, С. С. (2022). Усовершенствование анесте-зии у пожилых больных с сахарным диабетом при опе-рациях малого таза. Вестник науки и образования, (10-2 (130)), 65-69. 19. Гойибов, С. С. (2024). Динамика вариабельности сердечного ритма у пациентов с сахарным диабетом 2 типа во время спинальной анестезии с использованием дексмедетомидина. Research Journal of Trauma and Disability Studies, 3(5), 488-492. 20. Гойибов, С. С., & Бегматов, Ж. А. (2024). Оптими-зация Анестезии У Пациентов С Сопутствующими Заболеваниями Центральной Нервной Системы. Miasto Przyszłości, 54, 401-405. 21. Гойибов, С. С. (2024). Оптимизация предопераци-онной подготовки у больных с гипертонической бо-лезнью при проведении анестезии. Miasto Przyszłości, 54, 451-455.