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| Content Provider | World Health Organization (WHO)-Global Index Medicus |
|---|---|
| Author | Nakasuji, Masato Suh, Soon Hak Nomura, Masataka Nakamura, Mitsuyo Imanaka, Norie Tanaka, Masuji Nakasuji, Kae |
| Description | Country affiliation: Japan Author Affiliation: Nakasuji M ( Department of Anesthesiology, Kansai Denryoku Hospital, Osaka 553-0003, Japan.) |
| Abstract | STUDY OBJECTIVES: To determine the exact mechanism underlying spinal anesthesia-induced hypotension in the elderly patient. DESIGN: Retrospective case-control study. SETTING: Operating room (OR) in a general hospital. MEASUREMENTS: Records from 60 consecutive patients over 80 years 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 L(3)-L(4) intervertebral space in the lateral decubitus position, patients were turned supine. Acetate Ringer's solution (300 mL) was infused over 30 minutes after subarachnoid puncture. A decrease in systolic arterial pressure to less than 100 mmHg was treated with an intravenous injection of 5 mg 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. MEASUREMENTS: Cardiac output (CO) and stroke volume variation (SVV) every 20 seconds using the Vigileo-FloTrac system continuously from arrival in the operating room (OR) to 30 minutes 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. MAIN RESULTS: The decrease in SVR over 20 minutes 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 10 minutes 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. CONCLUSIONS: A decrease in SVR, not CO, is the main mechanism of hypotension seen during spinal anesthesia in elderly patients. |
| File Format | HTM / HTML |
| ISSN | 09528180 |
| Issue Number | 3 |
| Volume Number | 24 |
| e-ISSN | 18734529 |
| Journal | Journal of Clinical Anesthesia |
| Language | English |
| Publisher | Elsevier |
| Publisher Date | 2012-05-01 |
| Publisher Place | United States |
| Access Restriction | One Nation One Subscription (ONOS) |
| Subject Keyword | Discipline Anesthesiology Anesthesia, Spinal Adverse Effects Hypotension Chemically Induced Vascular Resistance Drug Effects Age Factors Aged, 80 And Over Methods Anesthetics, Local Administration & Dosage Bone Screws Bupivacaine Cardiac Output Case-control Studies Ephedrine Therapeutic Use Female Fracture Fixation, Intramedullary Hip Fractures Surgery Humans Male Retrospective Studies Stroke Volume Journal Article |
| Content Type | Text |
| Resource Type | Article |
| Subject | Anesthesiology and Pain Medicine |
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