title: Hemodynamic effects of spinal anesthesia in the elderly: single dose versus titration through a catheter.
abstract: Sixty elderly patients (> 70 yr old) undergoing surgery for hip fracture were prospectively studied in order to compare hemodynamic tolerance of titrated doses of hyperbaric bupivacaine using continuous spinal anesthesia (CSA) versus single-dose spinal anesthesia (SDSA). Patients were randomized into two groups (CSA group: n = 30; SDSA group: n = 30). The SDSA patients received 10-15 mg of 0.5% hyperbaric bupivacaine (based on age and height), and the CSA patients received a starting dose of 5 mg of 0.5% hyperbaric bupivacaine, followed after 15 min by optional reinjection of 2.5 mg every 5 min until a T10 level sensory block was reached. Onset of anesthesia, noninvasive hemodynamic variables and the need for ephedrine were studied for 4 h after induction of anesthesia. Spinal anesthesia was successful in all patients. Decreases in mean arterial pressure were significantly less frequent and less pronounced in the CSA group (19.9% +/- 1.6% of the baseline value) than in the SDSA group (40.2% +/- 1.9%, P < 0.0001). The mean dose of ephedrine was significantly less in the CSA group (1.8 +/- 0.7 mg, administered to only 37% of patients) than in the SDSA group (19.4 +/- 3.3 mg administered to all patients, P < 0.0001). No late complications related to the spinal anesthesia technique were observed in either group. We concluded that CSA, using small titrated doses of 0.5% hyperbaric bupivacaine, is safe, efficient, and provides better hemodynamic stability than SDSA in elderly patients.
authors.affiliation: Department of Emergency, Pellegrin University Hospital, Bordeaux, France.
authors.forename: J F
authors.initials: JF
authors.lastname: Favarel-Garrigues
authors.forename: F
authors.initials: F
authors.lastname: Sztark
authors.forename: M E
authors.initials: ME
authors.lastname: Petitjean
authors.forename: M
authors.initials: M
authors.lastname: Thicoïpé
authors.forename: P
authors.initials: P
authors.lastname: Lassié
authors.forename: P
authors.initials: P
authors.lastname: Dabadie
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000775:Anesthesia, Spinal / Q000379:methods*; D000779:Anesthetics, Local / Q000008:administration & dosage* / Q000494:pharmacology; D002045:Bupivacaine / Q000008:administration & dosage* / Q000494:pharmacology; D002404:Catheterization; D004809:Ephedrine / Q000008:administration & dosage; D005260:Female; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D007268:Injections, Epidural; D008297:Male; D011446:Prospective Studies
chemical_list: D000779:Anesthetics, Local; D004809:Ephedrine; D002045:Bupivacaine