title: Prophylactic phenylephrine infusion for the prevention of hypotension after spinal anesthesia in the elderly: a randomized controlled clinical trial.
abstract: OBJECTIVE
  Hypotension frequently occurs during spinal anesthesia (SA), especially in the elderly. Phenylephrine is effective to prevent SA-induced hypotension during cesarean delivery. The objective of this study was to evaluate the efficacy and safety of prophylactic infusion of phenylephrine after SA for orthopedic surgery in the elderly.
  
  
  METHODS
  This prospective, randomized, double-blind, and placebo-controlled study included 54 patients older than 60 years undergoing elective lower limb surgery under SA (injection of 10 mg of isobaric bupivacaine with 5 μg of sufentanyl).
  
  
  METHODS
  Patients were randomized to group P (100-μg/mL solution of phenylephrine solution at 1 mL/min after placement of SA) or the control group C (0.9% isotonic sodium chloride solution). The flow of the infusion was stopped if the mean arterial blood pressure (MAP) was higher than the baseline MAP and maintained or restarted at 1 mL/min if MAP was equal to or lower than the baseline MAP. Heart rate and MAP were collected throughout the case.
  
  
  METHODS
  Hypotension was defined by a 20% decrease and hypertension as a 20% increase from baseline MAP. Bradycardia was defined as a heart rate lower than 50 beats per minute.
  
  
  RESULTS
  Twenty-eight patients were randomized to group P and 26 patients to group C. MAP was higher in group P than in group C (92 ± 2 vs 82 ± 2 mm Hg, mean ± SD, P< .001). The number of hypotensive episodes per patient was higher in group C compared with group P (9 [0-39] vs 1 [0-10], median [extremes], P< .01), but the number of hypotensive patients was similar between groups (19 [73%] vs 20 [71%], P= 1). The time to onset of the first hypotension was shorter in group C (3 [1-13] vs 15 [1-95] minutes, P= .004). The proportion of patients without hypotension (cumulative survival) was better in group P (P= .04). The number of hypertensive episodes per patient and the number of bradycardic episodes per patient were similar between groups (P= not significant).
  
  
  CONCLUSIONS
  Prophylactic phenylephrine infusion is an effective method of reducing SA-induced hypotension in the elderly. Compared with a control group, it delays the time to onset of hypotension and decreases the number of hypotensive episodes per patient. More data are needed to evaluate clinical outcomes of such a strategy.
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Purpan University Hospital, Toulouse, France. Electronic address: Fabriceferre31@gmail.com.
authors.forename: Fabrice
authors.initials: F
authors.lastname: Ferré
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Purpan University Hospital, Toulouse, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Marty
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Purpan University Hospital, Toulouse, France.
authors.forename: Laura
authors.initials: L
authors.lastname: Bruneteau
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Purpan University Hospital, Toulouse, France.
authors.forename: Virgine
authors.initials: V
authors.lastname: Merlet
authors.affiliation: Department of Critical Care Medicine, Narbonne Hospital, Narbonne, France.
authors.forename: Benoît
authors.initials: B
authors.lastname: Bataille
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Purpan University Hospital, Toulouse, France.
authors.forename: Anne
authors.initials: A
authors.lastname: Ferrier
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Purpan University Hospital, Toulouse, France.
authors.forename: Claude
authors.initials: C
authors.lastname: Gris
authors.affiliation: Department of Anesthesia, University of Toronto, 150 College St, Room 121, Fitzgerald Bldg, Toronto, Ontario, M5S 3E2, Canada.
authors.forename: Matt
authors.initials: M
authors.lastname: Kurrek
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Purpan University Hospital, Toulouse, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Fourcade
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Purpan University Hospital, Toulouse, France.
authors.forename: Vincent
authors.initials: V
authors.lastname: Minville
authors.affiliation: Department of Medical and Clinical Pharmacology, Purpan Univserity Hospital, Toulouse, France.
authors.forename: Agnes
authors.initials: A
authors.lastname: Sommet
mesh_terms: D000759:Adjuvants, Anesthesia / Q000008:administration & dosage / Q000009:adverse effects; D058646:Adrenergic alpha-1 Receptor Agonists / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D000368:Aged; D000369:Aged, 80 and over; D000775:Anesthesia, Spinal / Q000009:adverse effects*; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000009:adverse effects*; D062186:Arterial Pressure / Q000187:drug effects*; D001919:Bradycardia / Q000139:chemically induced; D002045:Bupivacaine / Q000008:administration & dosage / Q000009:adverse effects; D004311:Double-Blind Method; D017558:Elective Surgical Procedures; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D006973:Hypertension / Q000139:chemically induced; D007022:Hypotension / Q000517:prevention & control*; D007262:Infusions, Intravenous; D035002:Lower Extremity / Q000601:surgery; D008875:Middle Aged; D019637:Orthopedic Procedures; D010656:Phenylephrine / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D011446:Prospective Studies; D017409:Sufentanil / Q000008:administration & dosage / Q000009:adverse effects; D016896:Treatment Outcome
chemical_list: D000759:Adjuvants, Anesthesia; D058646:Adrenergic alpha-1 Receptor Agonists; D000779:Anesthetics, Local; D010656:Phenylephrine; D017409:Sufentanil; D002045:Bupivacaine
keywords: Hypotension; Phenylephrine; Spinal anesthesia