Hypotension from spinal anesthesia in patients aged greater than 80 years is due to a decrease in systemic vascular resistance
Journal of Clinical Anesthesia,

Nakasuji M et al. – A decrease in systemic vascular resistance (SVR), not cardiac output (CO), is the main mechanism of hypotension seen during spinal anesthesia in elderly patients.

Methods
  • Records from 60 consecutive patients over 80years of age, who underwent hip fracture repair (intramedullary nail or compression hip screw) during spinal anesthesia were studied.
  • After injection of isobaric 0.5% bupivacaine in the L3-L4 intervertebral space in the lateral decubitus position, patients were turned supine.
  • Acetate Ringer’s solution (300mL) was infused over 30minutes after subarachnoid puncture.
  • A decrease in systolic arterial pressure to less than 100mmHg was treated with an intravenous injection of 5mg ephedrine.
  • The hypotension group (n=18) comprised patients who required ephedrine during the 30 minutes after the puncture, and the nonhypotension group (n=42) consisted of patients who maintained stable arterial pressure with crystalloid infusion only.
  • Cardiac output (CO) and stroke volume variation (SVV) every 20seconds using the Vigileo-FloTrac system continuously from arrival in the operating room (OR) to 30minutes after the subarachnoid puncture were recorded.
  • Serial changes in systemic vascular resistance (SVR), CO, and SVV from baseline after puncture were compared between the two groups.

Results
  • The decrease in SVR over 20minutes after the puncture was significantly greater in the hypotension group than the nonhypotension group (P=0.047).
  • Cardiac output was stable in the two groups.
  • Stroke volume variation in the first 10minutes after the puncture increased to similar levels in the two groups, then decreased gradually to baseline.
  • No significant differences were noted in circulatory parameters on arrival at the OR.

Please login or register to follow this author.
Are you sure you want to Unfollow this Author?
► Click here to access PubMed, Publisher and related articles...
<< Previous Article | Next Article >>

Your Unread Messages in Medical Student

See All >> Messages include industry-sponsored communications and special communications from MDLinx

Most Popular Medical Student Articles

1 Effect of pentoxifylline on renal function and urinary albumin excretion in patients with diabetic kidney disease: The PREDIAN trial Journal of the American Society of Nephrology, June 30, 2014    Clinical Article

2 Oral bisphosphonate use and total knee/hip implant survival: Validation of results in an external population-based cohort Arthritis & Rheumatism, August 13, 2014    Clinical Article

3 Vancomycin-resistant enterococci colonization among dialysis patients: A meta-analysis of prevalence, risk factors, and significance American Journal of Kidney Diseases, July 18, 2014    Review Article

4 Regular fish consumption and age-related brain gray matter loss American Journal of Preventive Medicine, August 15, 2014    Clinical Article

5 Pistachio nut consumption modifies systemic hemodynamics, increases heart rate variability, and reduces ambulatory blood pressure in well-controlled type 2 diabetes: A randomized trial Full Text Journal of the American Heart Association, September 19, 2014    Free full text

6 Old medications and new targeted therapies in systemic sclerosis Rheumatology, August 1, 2014    Review Article

7 Long-term high-dose vitamin D3 supplementation and blood pressure in healthy adults Hypertension, September 26, 2014    Clinical Article

8 A systematic review investigating interventions that can help reduce consumption of sugar-sweetened beverages in children leading to changes in body fatness Journal of Human Nutrition and Dietetics, September 26, 2014    Review Article

9 Nutrition for the prevention and treatment of chronic kidney disease in diabetes Canadian Journal of Diabetes, September 26, 2014    Review Article

10 Factors that affect efficacy of ultrasound surveillance for early stage hepatocellular carcinoma in patients with cirrhosis Clinical Gastroenterology and Hepatology , September 26, 2014    Clinical Article

11 Rationale and design of the vitamin D and type 2 diabetes (D2d) study: a diabetes prevention trial Diabetes Care, September 11, 2014    Clinical Article

12 Dietary folate and reproductive success among women undergoing assisted reproduction Obstetrics and Gynecology, September 26, 2014    Clinical Article

13 Gradual reduction of cigarette consumption as a cessation strategy: Prevalence, correlates, and relationship with quitting Nicotine & Tobacco Research, September 26, 2014    Clinical Article

14 Appropriateness of imaging for lung cancer staging in a National Cohort Journal of Clinical Oncology, September 26, 2014    Clinical Article

15 Vitamin d receptor genetic polymorphism is significantly associated with decreased risk of hypertension in a Chinese han population The Journal of Clinical Hypertension, September 26, 2014    Clinical Article

16 Cost-effectiveness analysis of an enteral nutrition protocol for children with common gastrointestinal diseases in China: good start but still a long way to go Journal of Parenteral and Enteral Nutrition, September 26, 2014    Clinical Article

17 Epidemiology of primary Sjogren's syndrome: A systematic review and meta-analysis Annals of Rheumatic Diseases, August 28, 2014    Evidence Based Medicine    Review Article

18 Crosstalk between gastrointestinal neurons and the brain in the control of food intake Best Practice & Research Clinical Endocrinology & Metabolism, September 26, 2014    Clinical Article

19 Relationship between whole-body macronutrient oxidative partitioning and pancreatic insulin secretion/β-cell function in non-diabetic humans Metabolism, September 26, 2014    Clinical Article

20 Is age a better predictor of weight loss one year after gastric bypass than symptoms of disordered eating, depression, adult ADHD and alcohol consumption? Eating Behaviours, September 26, 2014    Clinical Article

Indexed Journals in Medical Student: Academic Medicine, BMC Medical Education, Medical Teachermore

Register now to view all the MDLinx contents (FREE)!

  • Stay current on the latest literature, research and clinical news
  • Get special communications and offers from MDLinx and our sponsors
  • Receive invitations to paid market research
View Samples and Register

Connect with us, stay current.

Receive the latest mecial news
updates for free via email

Sign up!

Subscribe to our free RSS feeds:

Get the latest news in your specialty automatically added to your newsreader or your personal My Yahoo!, Google, My MSN or My AOL page. Learn More

Close