[Comparison of the hemodynamic response in subarachnoid anesthesia with bupivacaine versus bupivacaine with fentanyl in traumatology surgery in elderly patients].
OBJECTIVE
To compare the intraoperative hemodynamic effects and ephedrine requirements in elderly patients undergoing orthopedic surgery under subarachnoid anesthesia with hyperbaric bupivacaine with or without fentanyl.


METHODS
Sixty patients over 75 years of age and scheduled for semi-urgent surgical repair of a fractured femur were randomized to two groups. Group F received subarachnoid surgery with 5 mg of bupivacaine and 15 micrograms of fentanyl. Group B received 7.5 mg bupivacaine. We recorded blood pressure, heart rate and oxygen saturation every 5 minutes and extension of anesthesia. Hemodynamic changes and ephedrine required by each patient were analyzed, along with side effects.


RESULTS
Group F patients were more hemodynamically stable 10 and 20 minutes after infusion of the anesthetic, and more hypotensive episodes occurred in group B. Group B consumed significantly more ephedrine (p < 0.05), administered to 22 patients in group B and 6 in group F. The total dose of ephedrine administered was greater in group B (190 mg) than in group F (40 mg). The extension of anesthetic block was sufficient for surgery in all cases. No side effects from fentanyl administration were observed.


CONCLUSIONS
Adding fentanyl to the local anesthetic used for subarachnoid anesthesia in elderly patients is effective for maintaining greater hemodynamic stability, allowing use of a lower dose of hyperbaric bupivacaine and reducing the need for intravenous ephedrine during surgery.
Alonso Chico
A
A
Servicio de Anestesiología y Reanimación, Hospital General Universitario Gregorio Marañón, Madrid.
Cruz Pardos
P
P
Alvarez Grau
J
J
Pachoco Jiménez
A
A
Arregui Martínez de Lejarza
M
M
Sánchez García
M L
ML
Cardona Valdés
A
A
D000368:Aged; D000369:Aged, 80 and over; D000775:Anesthesia, Spinal; D019162:Anesthetics, Combined / Q000008:administration & dosage* / Q000494:pharmacology; D018686:Anesthetics, Intravenous / Q000008:administration & dosage* / Q000494:pharmacology; D000779:Anesthetics, Local / Q000008:administration & dosage* / Q000494:pharmacology; D002045:Bupivacaine / Q000008:administration & dosage*; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage*; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D007432:Intraoperative Period; D008297:Male; D019637:Orthopedic Procedures
D019162:Anesthetics, Combined; D018686:Anesthetics, Intravenous; D000779:Anesthetics, Local; D005283:Fentanyl; D002045:Bupivacaine
Comparación de la respuesta hemodinámica en la anestesia subaracnoidea con bupivacaína frente a bupivacaína con fentanilo en cirugía traumatológica en ancianos.