Is it possible to predict hypotension during onset of spinal anesthesia in elderly patients?
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.
Meyhoff
Christian S
CS
Department of Anaesthesia, Centre of Head and Orthopaedics, Copenhagen University Hospital, Rigshospitalet, DK-2100 Copenhagen, Denmark. meyhoff@rh.dk
Haarmark
Christian
C
Kanters
Jørgen K
JK
Rasmussen
Lars S
LS
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
D018663:Adrenergic Agents; D000779:Anesthetics, Local; D004809:Ephedrine; D002045:Bupivacaine