title: Cardiovascular effects of low-dose spinal anaesthesia as a function of age: An observational study using echocardiography.
abstract: BACKGROUND
  Spinal anaesthesia (SA) is a widely used technique of regional anaesthesia but hypotension is an adverse effect commonly observed, especially in elderly patients.
  
  
  OBJECTIVE
  The objective of this study was to assess the cardiovascular effects induced by a single injection of a low-dose SA during elective surgery by using transthoracic echocardiography (TTE) and to compare these effects in patients older and younger than 70 years of age.
  
  
  METHODS
  Observational study.
  
  
  METHODS
  Single centre university hospital.
  
  
  METHODS
  Forty-six patients scheduled for surgery under SA were included in the study (25 patients<70 years and 21 patients ≥ 70 years).
  
  
  METHODS
  A cardiologist, blinded to all clinical parameters, interpreted the TTE.
  
  
  METHODS
  Two TTEs were performed for each patient: one at baseline before and the second 20 minutes after the placement of the SA.
  
  
  RESULTS
  Sixty-six percent of patients became hypotensive in the ≥ 70 years group whereas no episode of hypotension occurred in the<70 years group (P<0.0001). At baseline (i.e. prior to SA), when compared to younger patients, elderly patients had both a lower E/A ratio (0.8 [0.5-2.1] vs. 1.4 [0.7-1.6], P=0.001) as well as a lower LVEF (50.4% [37.7-72.3] vs. 60.9% [44.8-69.8], P<0.0001). SA in the elderly induced a larger decrease in the cardiac index (CI) (-0.5 L·min(-1)·m(-2) [-0.8 to -0.3] vs. -0.2 L·min(-1)·m(-2) [-0.8-0.1], P<0.0001), LV stroke volume (-8mL [-13-4] vs. -2mL [-14 to -1], P<0.0001) and systemic vascular resistances (SVR) (-2.2 WU [-6.7-0.3] vs. -0.8 WU [-2.3-0.1], P<0.0001).
  
  
  CONCLUSIONS
  Hypotension is more frequent among elderly patients, even after low-dose SA. Known age-related changes in cardiovascular performance, such as impaired myocardial relaxation and decreased systolic function could be responsible for the decrease in cardiac output (CO) and SVR seen in these patients.
authors.affiliation: Department of Nuclear Medicine, Toulouse University Hospital, 1, avenue Jean-Poulhès, TSA 50032, 31059 Toulouse cedex 9, France; Department of Cardiology, Toulouse University Hospital, 1, avenue Jean-Poulhès, TSA 50032, 31059 Toulouse cedex 9, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Lairez
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, Faculty of Medicine of Toulouse-Rangueil, University of Toulouse III Paul Sabatier, 31000 Toulouse, France.
authors.forename: Fabrice
authors.initials: F
authors.lastname: Ferré
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, Faculty of Medicine of Toulouse-Rangueil, University of Toulouse III Paul Sabatier, 31000 Toulouse, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Portet
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, Faculty of Medicine of Toulouse-Rangueil, University of Toulouse III Paul Sabatier, 31000 Toulouse, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Marty
authors.affiliation: Department of Cardiology, Toulouse University Hospital, 1, avenue Jean-Poulhès, TSA 50032, 31059 Toulouse cedex 9, France; Department of Anaesthesiology and Intensive Care Medicine, Faculty of Medicine of Toulouse-Rangueil, University of Toulouse III Paul Sabatier, 31000 Toulouse, France.
authors.forename: Clément
authors.initials: C
authors.lastname: Delmas
authors.affiliation: Department of Cardiology, Toulouse University Hospital, 1, avenue Jean-Poulhès, TSA 50032, 31059 Toulouse cedex 9, France.
authors.forename: Thomas
authors.initials: T
authors.lastname: Cognet
authors.affiliation: Department of Anaesthesia, University of Toronto, 150, College Street, Room 121, Fitzgerald Building, Toronto M5S 3E2, Ontario, Canada.
authors.forename: Matt
authors.initials: M
authors.lastname: Kurrek
authors.affiliation: Department of Cardiology, Toulouse University Hospital, 1, avenue Jean-Poulhès, TSA 50032, 31059 Toulouse cedex 9, France.
authors.forename: Didier
authors.initials: D
authors.lastname: Carrié
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, Faculty of Medicine of Toulouse-Rangueil, University of Toulouse III Paul Sabatier, 31000 Toulouse, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Fourcade
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, Faculty of Medicine of Toulouse-Rangueil, University of Toulouse III Paul Sabatier, 31000 Toulouse, France. Electronic address: minville.v@chu-toulouse.fr.
authors.forename: Vincent
authors.initials: V
authors.lastname: Minville
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D000775:Anesthesia, Spinal / Q000009:adverse effects*; D001794:Blood Pressure / Q000187:drug effects; D002302:Cardiac Output / Q000187:drug effects; D004452:Echocardiography; D005260:Female; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D007022:Hypotension / Q000209:etiology / Q000503:physiopathology; D007431:Intraoperative Complications / Q000139:chemically induced / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction / Q000187:drug effects; D013318:Stroke Volume / Q000187:drug effects; D014655:Vascular Resistance / Q000187:drug effects; D055815:Young Adult
keywords: Echocardiography; Elderly; Low dose; Spinal anesthesia