title: Postspinal hypotension in elderly patients undergoing orthopedic surgery, prophylactic ephedrine versus polygeline 3.5.
abstract: BACKGROUND
  Perioperative fluid management in elderly poses considerable challenge to the anesthesiologist. The conventional crystalloid loading may not be a preferred regime in this subgroup of patients since an exaggerated hemodynamic response is expected due to blunted sympathetic response and compromised cardiorespiratory system.
  
  
  OBJECTIVE
  This study was designed in the elderly patient for comparing efficacy, side-effects and limitations of prophylactic ephedrine 30 mg (intramuscular [i.m.]) versus polygeline 3.5% 500 ml (intravenous [i.v.]) for the maintenance of blood pressure after subarachnoid block (SAB).
  
  
  METHODS
  The sample size of 100 elderly (age > 50 years) patients undergoing orthopedic surgeries was administered SAB using bupivacaine 0.5% heavy. The primary outcome of this study was the attenuation of hypotension due to SAB using ephedrine or polygeline 3.5%.
  
  
  METHODS
  A total of 100 patients were randomly allocated to receive ephedrine 30 mg i.m. 10 min before the institution of SAB in Group I and preloading with 500 ml of polygeline 3.5% i.v. over 10 min prior to SAB in Group II. Patients in both groups were closely monitored for pulse rate, systolic blood pressure; any hypotension, requirement of rescue therapy and adverse effects.
  
  
  METHODS
  Results were interpreted using Student's t-test for parametric and Chi-square tests for nonparametric data.
  
  
  RESULTS
  The incidence of hypotension and requirement for rescue therapy was statistically less in Group I compared with Group II (P < 0.05). Heart rates were better maintained in Group I than Group II, with few hemodynamic adverse effects in both groups.
  
  
  CONCLUSIONS
  Ephedrine 30 mg i.m. given as pretreatment before SAB in elderly patients was more effective for the prevention of post-SAB hypotension.
authors.affiliation: Department of Anaesthesia, SGRDIMS and R, Sri Amritsar, Punjab, India.
authors.forename: Saru
authors.initials: S
authors.lastname: Singh
authors.affiliation: Department of Anaesthesia, BJ Medical College and Civil Hospital, Ahmedabad, Gujarat, India.
authors.forename: Trupti D
authors.initials: TD
authors.lastname: Shah
authors.affiliation: Department of Anaesthesia, SGRDIMS and R, Sri Amritsar, Punjab, India.
authors.forename: Ruchi
authors.initials: R
authors.lastname: Gupta
authors.affiliation: Department of Anaesthesia, SGRDIMS and R, Sri Amritsar, Punjab, India.
authors.forename: Preetween
authors.initials: P
authors.lastname: Kaur
authors.affiliation: Department of Anaesthesia, SGRDIMS and R, Sri Amritsar, Punjab, India.
authors.forename: Chiteshwar S
authors.initials: CS
authors.lastname: Walia
authors.affiliation: Department of Anaesthesia, Paras Hospital, Gurgaon, Haryana, India.
authors.forename: Saroj
authors.initials: S
authors.lastname: Sehrawat
keywords: Ephedrine; elderly; hypotension polygeline 3.5%; subarachnoid block