title: Is it possible to predict hypotension during onset of spinal anesthesia in elderly patients?
abstract: OBJECTIVE
  To evaluate the sensitivity and specificity of various predictors of hypotension during onset of spinal anesthesia in elderly patients.
  
  
  METHODS
  Prospective study.
  
  
  METHODS
  32 ASA physical status I, II, and III patients, aged >or=60 years, scheduled for elective lower limb surgery with spinal anesthesia.
  
  
  METHODS
  Patients received spinal anesthesia with 10-17.5 mg of bupivacaine. No prophylactic ephedrine or fluid preloading was used.
  
  
  METHODS
  A 5-minute baseline was recorded and during onset of spinal anesthesia, hemodynamic changes were measured every 10 seconds from the radial artery pressure curve. Data collection ended when patients were ready for surgery, or if ephedrine was given to increase mean arterial pressure.
  
  
  RESULTS
  21 patients had hypotension. Baseline blood pressure variability low-frequency band power (BPV LF) >8 mmHg(2) and near-infrared spectroscopy (NIRS) reduction >or=5% had high sensitivity (0.73 and 0.90, respectively) and specificity (0.78 and 0.64, respectively), and were significantly associated with the development of hypotension.
  
  
  CONCLUSIONS
  Only NIRS and BPV LF could significantly predict hypotension among the elderly.
authors.affiliation: Department of Anaesthesia, Centre of Head and Orthopaedics, Copenhagen University Hospital, Rigshospitalet, DK-2100 Copenhagen, Denmark. meyhoff@rh.dk
authors.forename: Christian S
authors.initials: CS
authors.lastname: Meyhoff
authors.forename: Christian
authors.initials: C
authors.lastname: Haarmark
authors.forename: Jørgen K
authors.initials: JK
authors.lastname: Kanters
authors.forename: Lars S
authors.initials: LS
authors.lastname: Rasmussen
mesh_terms: D018663:Adrenergic Agents / Q000627:therapeutic use; D000368:Aged; D000369:Aged, 80 and over; D000775:Anesthesia, Spinal / Q000009:adverse effects; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000009:adverse effects*; D001795:Blood Pressure Determination / Q000379:methods; D002045:Bupivacaine / Q000008:administration & dosage / Q000009:adverse effects*; D004809:Ephedrine / Q000627:therapeutic use; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D007022:Hypotension / Q000139:chemically induced*; D035002:Lower Extremity / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D017534:Radial Artery
chemical_list: D018663:Adrenergic Agents; D000779:Anesthetics, Local; D004809:Ephedrine; D002045:Bupivacaine