title: Hemodynamic changes associated with spinal and general anesthesia for hip fracture surgery in severe ASA III elderly population: a pilot trial.
abstract: BACKGROUND
  Patients affected by hip fracture (HF) have high risk of perioperative complications. Despite regional anesthesia is widely used, hypotension is common and increases the risk of myocardial ischemia. The aim of this work was to study hemodynamic changes following spinal (SA) and general (GA) anesthesia in this selected population of patients.
  
  
  METHODS
  Twenty patients over 70 years, ASA III, scheduled for HF repair were randomized to receive SA or general anesthesia GA. Hemodynamic responses to SA and GA were analyzed trough LiDCO™plus monitor (LiDCO Ltd., Cambridge, UK).
  
  
  RESULTS
  SA provided a more stable hemodynamic profile. SA group received less interventions to keep mean arterial pressure (MAP) within limits. GA group had intraoperative cardiac index (CI), stroke volume index (SVI) and MAP significantly lower than baseline. Despite both groups experienced hypotension after the induction, MAP reduction in SA group was primarily due to systemic vascular resistance index (SVRI) decline, whereas hypotension in GA group was primarily due to a reduction in SVI and CI. The coefficient of variation (CV) was significantly higher in GA group for CI, SVI, MAP and heart rate (HR) within one hour analysis comparing to SA group. SA group had an higher CV for SVRI.
  
  
  CONCLUSIONS
  SA in the elderly population with hip fracture provides a more stable hemodynamic profile requiring less intervention to keep MAP close to baseline value. Hypotension was common in SA and GA after induction and within intraoperative period. A larger randomized clinical study should be performed to confirm these preliminary data.
authors: Dipartimento di Medicina Clinica e Sperimentale - Anestesia e Rianimazione, Università del Piemonte Orientale "A. Avogadro", Novara, Italia - mess81rc@libero.it.
authors: A
authors: A
authors: Messina
authors: L
authors: L
authors: Frassanito
authors: D
authors: D
authors: Colombo
authors: A
authors: A
authors: Vergari
authors: G
authors: G
authors: Draisci
authors: F
authors: F
authors: Della Corte
authors: M
authors: M
authors: Antonelli
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000768:Anesthesia, General / Q000009:adverse effects*; D000775:Anesthesia, Spinal / Q000009:adverse effects*; D005260:Female; D006439:Hemodynamics / Q000187:drug effects*; D006620:Hip Fractures / Q000150:complications / Q000601:surgery*; D006801:Humans; D007022:Hypotension / Q000453:epidemiology / Q000209:etiology; D007430:Intraoperative Care; D008297:Male; D010865:Pilot Projects