title: Comparison of hemodynamic changes between old and very old patients undergoing cemented bipolar hemiarthroplasty under spinal anesthesia.
abstract: BACKGROUND
  The old age population, including the very old aged (≥ 85 years), is rapidly increasing, and femur neck fracture from accidents is commonly seen in the elderly. Use of bone cement during bipolar hemiarthroplasty can cause bone cement implantation syndrome.
  
  
  METHODS
  This study was prospectively conducted on the elderly who were scheduled to undergo elective cemented bipolar hemiarthroplasty under spinal anesthesia. Patients were divided into 2 groups: the old age (65-84 years) and very old age groups (≥ 85 years). Hemodynamic parameters were recorded at the following time points: the start of the operation, femoral reaming, cement insertion, every 2 minutes after cement insertion for 10 minutes, femoral joint reduction, and the end of operation. When hypotension occurred, ephedrine was given.
  
  
  RESULTS
  Sixty-five patients in the old age group and 32 patients in the very old age group were enrolled. Mean ages were 78.9 and 89.4 years, respectively, in the old age and very old age groups. The very old age group showed constantly decreased levels of cardiac index and stroke volume from cementing until the end of the operation compared to the old age group. To maintain hemodynamic stability after cement insertion, the requirement of ephedrine was higher in the very old age group than in the old age group (13.52 ± 7.76 vs 8.65 ± 6.38 mg, P = 0.001).
  
  
  CONCLUSIONS
  Bone cement implantation during bipolar hemiarthroplasty may cause more prominent hemodynamic changes in very elderly patients. Careful hemodynamic monitoring and management are warranted in very elderly patients undergoing cemented bipolar hemiarthroplasty.
authors: Department of Anesthesiology and Pain Medicine, Eulji General Hospital, Eulji University, Seoul, Korea.
authors: Hye Jin
authors: HJ
authors: Park
authors: Department of Anesthesiology and Pain Medicine, Eulji General Hospital, Eulji University, Seoul, Korea.
authors: Hyoseok
authors: H
authors: Kang
authors: Department of Anesthesiology and Pain Medicine, Eulji General Hospital, Eulji University, Seoul, Korea.
authors: Jae-Woo
authors: JW
authors: Lee
authors: Department of Anesthesiology and Pain Medicine, Eulji General Hospital, Eulji University, Seoul, Korea.
authors: Seung Min
authors: SM
authors: Baek
authors: Department of Anesthesiology and Pain Medicine, Eulji General Hospital, Eulji University, Seoul, Korea.
authors: Jeong Seung
authors: JS
authors: Seo
keywords: Aged; Bone cements; Hemiarthroplasty; Hemodynamics; Spinal anesthesia