A comparison of three fluid-vasopressor regimens used to prevent hypotension during subarachnoid anaesthesia in the elderly.
We aimed to compare the efficacy of fluid preloading with two recently recommended fluid-vasopressor regimens for maintaining blood pressure during subarachnoid anaesthesia in the elderly. Sixty elderly patients requiring surgery for traumatic hip fractures received subarachnoid anaesthesia using 0.05 ml/kg of 0.5% heavy bupivacaine. Hypotension, i.e. systolic arterial pressure < 75% of baseline, was prevented or treated by: A--normal saline 16 ml/kg plus intravenous ephedrine boluses (0.1 mg/kg); B--normal saline 8 ml/kg plus intramuscular depot ephedrine (0.5 mg/kg); or C--Haemaccel 8 ml/kg plus metaraminol infusion. Systolic arterial pressure and heart rate were recorded using custom-written computer software (Monitor, version 1.0). Systolic arterial pressure decreased in all groups after five minutes (P < 0.001). Decreases were greatest in group A (P < 0.05). Heart rate increased by 7% group A and decreased by 9% in group C (P < 0.05). During the first hour, hypotension was present for 47%, 25% and 20% of the time in groups A, B and C respectively and overcorrection of systolic arterial pressure occurred in 19% of the time in group C. We conclude that treatment A was inadequate in preventing hypotension. Treatments B and C were more effective but were associated with an increased heart rate and overcorrection of systolic arterial pressure respectively.
Yap
J C
JC
Department of Anaesthesia and Intensive Care, Chinese University of Hong Kong, Prince of Wales Hospital.
Critchley
L A
LA
Yu
S C
SC
Calcroft
R M
RM
Derrick
J L
JL
D000368:Aged; D000369:Aged, 80 and over; D000775:Anesthesia, Spinal; D004809:Ephedrine / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D005265:Femoral Neck Fractures / Q000601:surgery; D006801:Humans; D007022:Hypotension / Q000517:prevention & control*; D007431:Intraoperative Complications / Q000517:prevention & control*; D008297:Male; D008680:Metaraminol / Q000008:administration & dosage / Q000627:therapeutic use*; D010952:Plasma Substitutes / Q000008:administration & dosage; D011097:Polygeline / Q000008:administration & dosage; D012965:Sodium Chloride / Q000008:administration & dosage; D014662:Vasoconstrictor Agents / Q000008:administration & dosage / Q000627:therapeutic use*
D010952:Plasma Substitutes; D014662:Vasoconstrictor Agents; D012965:Sodium Chloride; D008680:Metaraminol; D011097:Polygeline; D004809:Ephedrine