A cohort study of anatomical landmark-guided midline versus pre-procedure ultrasound-guided midline technique of spinal anesthesia in elderly patients undergoing orthopedic surgery

Narkhede, Harsha; Kane, Deepa; Parekh, Viral; Hemantkumar, Indrani

doi:10.4103/joacp.joacp_396_17

Cited by 6 publications

(1 citation statement)

References 18 publications

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“…10 In two-thirds of the cases herein, failure was due to the impossibility to localize the subarachnoid space that is known to be more difficult in the elderly, as they exhibit narrow interspinous and interlaminar spaces, ossification of ligaments, and hypertrophy of facet joints. 33 In the other one-third of cases, patients experienced an inadequate block, 2 of whom had an inadequate motor blockade at the end of surgery that lasted >1 hour. Therefore, inadequate block was not directly related to the HUSA protocol in most cases.…”

Section: Anesthesia and Analgesiamentioning

confidence: 98%

Hypobaric Unilateral Spinal Anesthesia Versus General Anesthesia for Hip Fracture Surgery in the Elderly: A Randomized Controlled Trial

Simonin

Delsuc

Meuret

et al. 2022

Anesthesia &Amp; Analgesia

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BACKGROUND: Hypotension during surgery is frequent in the elderly population and is associated with acute kidney and myocardial injury, which are, themselves, associated with increased 30-day mortality. The present study compared the hemodynamic effects of hypobaric unilateral spinal anesthesia (HUSA) to general anesthesia (GA) in patients ≥70 years of age undergoing hip fracture surgery. METHODS: We conducted a single-center, prospective, randomized study. In the HUSA group, patients were positioned with the operated hip above, and the hypobaric anesthetic solution was composed of 9 mg ropivacaine, 5 µg sufentanil, and 1 mL of sterile water. Anesthesia was adjusted for the GA group. Mean arterial pressure (MAP) was measured with a noninvasive blood pressure upper arm cuff every 3 minutes. Hypotension was treated with a bolus of ephedrine and then a continuous intravenous of norepinephrine to obtain a MAP ≥65 mm Hg. Primary outcome was the occurrence of severe hypotension, defined as a MAP <65 mm Hg for >12 consecutive minutes. RESULTS: A total of 154 patients were included. Severe hypotension was more frequent in the GA group compared to the HUSA group (odds ratio, 5.6; 95% confidence interval, 2.7-11.7; P < .001). There was no significant difference regarding the short-term outcomes between the HUSA and GA groups: acute kidney injury (respectively, 5.1% vs 11.3%; P = .22), myocardial injury (18.0% vs 14.0%; P = .63), and 30-day mortality (2.4% vs 4.7%; P = .65). CONCLUSIONS: HUSA leads to fewer episodes of severe intraoperative hypotension compared to GA in an elderly population undergoing hip fracture surgery.

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Section: Anesthesia and Analgesiamentioning

confidence: 98%