Spinal anesthesia (SA) is generally regarded as a safe technique, but it can cause side effects such as hypotension and bradycardia. Hypotension mainly results from sympathetic nerve blockade and vasodilation. Although elderly patients face a higher risk of hypotension and its complications, spinal anesthesia is more commonly used in this population. The incidence of hypotension in elderly patients is estimated to exceed 70%. Preventing hypotension in these patients poses a challenge, as the measures taken may increase the risk of hypervolemia or myocardial ischemia. Both hypotension and bradycardia can be triggered by the Bezold-Jarisch reflex (BJR); spinal anesthesia reduces preload, which activates the BJR, potentially via peripheral serotonin (5HT-3) receptors. These receptors are found on cardiac vagal afferents peripherally and in the central chemoreceptor trigger zone. Shivering frequently occurs during and after spinal anesthesia. Its exact cause is not well defined but likely involves several factors, such as altered thermoregulatory thresholds, decreased core body temperature, redistribution of body heat, and the cooling effect of fluids injected into the neuraxis. Although shivering causes significant discomfort, it also produces interference with monitoring equipment and elevates postoperative pain, heart rate, oxygen consumption, and metabolic rate. These effects can contribute to myocardial ischemia, hypoxemia, hypercarbia, and lactic acidosis.
Spinal anesthesia, Hypotension, Bradycardia, Bezold-Jarisch reflex (BJR), Shivering.
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