title: Hemodynamic profile of target-controlled spinal anesthesia compared with 2 target-controlled general anesthesia techniques in elderly patients with cardiac comorbidities.
abstract: OBJECTIVE
  The impact of anesthesia techniques in patients experiencing hip fracture is controversial. This study compares the effects on blood pressure of 3 anesthesia techniques that are considered safe for the elderly.
  
  
  METHODS
  Forty-five patients older than 75 years, with American Society of Anesthesiologists physical status III or IV, with cardiac comorbidities, and undergoing surgery for hip fracture, were randomized to receive continuous spinal anesthesia (CSA), propofol target-controlled infusion (TCI), or sevoflurane (SEVO). In CSA patients, a T10 metameric level target was achieved by titration of 2.5 mg of bupivacaine boluses. In patients on TCI and SEVO, a bispectral value target of around 50 guided the concentration of propofol or sevoflurane. Analgesia in the TCI and SEVO groups was provided with remifentanil. Hypotension was defined as a 30% decrease in mean arterial pressure and was treated with an intravenous bolus of ephedrine.
  
  
  RESULTS
  The number of hypotension episodes was lower in the CSA group: 0 (range, 0-6) versus 11.5 (range, 1-25) in the TCI group and 10 (range, 1-23) in the SEVO group (P < 0.001). Both TCI and SEVO patients needed more ephedrine compared with CSA patients (30.5 [15.5], 26 [23], and 1.5 [2.5] mg, respectively, P < 0.001). The maximal decrease in mean arterial pressure was lower in the CSA group (26% [17%]) compared with that in the TCI group (47% [8%]) and the SEVO group (46% [12%]; P < 0.001).
  
  
  CONCLUSIONS
  In elderly patients, spinal anesthesia using titrated doses of bupivacaine provided better blood pressure stability than propofol or sevoflurane anesthesia.
authors.affiliation: Departments of Anesthesiology and Critical Care, Lapeyronie University Hospital, 371 Av. Giraud, Montpellier, France. p-biboulet@chu-montpellier.fr
authors.forename: Philippe
authors.initials: P
authors.lastname: Biboulet
authors.forename: Alexandre
authors.initials: A
authors.lastname: Jourdan
authors.forename: Vera
authors.initials: V
authors.lastname: Van Haevre
authors.forename: Didier
authors.initials: D
authors.lastname: Morau
authors.forename: Nathalie
authors.initials: N
authors.lastname: Bernard
authors.forename: Sophie
authors.initials: S
authors.lastname: Bringuier
authors.forename: Xavier
authors.initials: X
authors.lastname: Capdevila
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000768:Anesthesia, General / Q000379:methods*; D000775:Anesthesia, Spinal / Q000379:methods*; D001794:Blood Pressure / Q000187:drug effects*; D002045:Bupivacaine / Q000494:pharmacology; D015897:Comorbidity; D005260:Female; D006331:Heart Diseases / Q000503:physiopathology; D006620:Hip Fractures / Q000601:surgery; D006801:Humans; D008297:Male; D008738:Methyl Ethers / Q000494:pharmacology; D015742:Propofol / Q000494:pharmacology; D000077149:Sevoflurane
chemical_list: D008738:Methyl Ethers; D000077149:Sevoflurane; D002045:Bupivacaine; D015742:Propofol