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A Comparison of Three Fluid-Vasopressor Regimens Used to Prevent Hypotension During Subarachnoid Anaesthesia in the Elderly

A Comparison of Three Fluid-Vasopressor Regimens Used to Prevent Hypotension During Subarachnoid Anaesthesia in the Elderly

J C Yap, L A Critchley, S C Yu, R M Calcroft, J L Derrick

Anaesth Intensive Care. 1998 Oct;26(5):497-502.

PMID: 9807603

Abstract:

We aimed to compare the efficacy of fluid preloading with two recently recommended fluid-vasopressor regimens for maintaining blood pressure during subarachnoid anaesthesia in the elderly. Sixty elderly patients requiring surgery for traumatic hip fractures received subarachnoid anaesthesia using 0.05 ml/kg of 0.5% heavy bupivacaine. Hypotension, i.e. systolic arterial pressure < 75% of baseline, was prevented or treated by: A--normal saline 16 ml/kg plus intravenous ephedrine boluses (0.1 mg/kg); B--normal saline 8 ml/kg plus intramuscular depot ephedrine (0.5 mg/kg); or C--Haemaccel 8 ml/kg plus metaraminol infusion. Systolic arterial pressure and heart rate were recorded using custom-written computer software (Monitor, version 1.0). Systolic arterial pressure decreased in all groups after five minutes (P < 0.001). Decreases were greatest in group A (P < 0.05). Heart rate increased by 7% group A and decreased by 9% in group C (P < 0.05). During the first hour, hypotension was present for 47%, 25% and 20% of the time in groups A, B and C respectively and overcorrection of systolic arterial pressure occurred in 19% of the time in group C. We conclude that treatment A was inadequate in preventing hypotension. Treatments B and C were more effective but were associated with an increased heart rate and overcorrection of systolic arterial pressure respectively.

Chemicals Related in the Paper:

Catalog Number	Product Name	Structure	CAS Number	Price
AP33402038-B	Metaraminol (+)-bitartrate salt		33402-03-8	Price

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