Dexamethasone blunts postspinal hypotension in geriatric patients undergoing orthopedic surgery: a double blind, placebo-controlled study

Abstract

Background Post-spinal anesthesia (PSA) hypotension in elderly patients is challenging. Correction of PSA hypotension by fluids either colloids or crystalloids or by vasoconstrictors pose the risk of volume overload or compromising cardiac conditions. Dexamethasone is used to treat conditions manifested by decrease of peripheral vascular resistance. The research team was the first to test the hypothesis of its role in preventing or decreasing the incidence of PSA hypotension. Methods One hundred ten patients, aged 60 years or more were recruited to receive a single preoperative dose of dexamethasone 8 mg IVI in 100 ml normal saline (D group) (55 patients) 2 h preoperatively, and 55 patients were given placebo (C group) in a randomized, double-blind trial. Variations in blood pressure and heart rate in addition to the needs of ephedrine and/or atropine following spinal anesthesia (SA) were recorded. SA was achieved using subarachnoid injection of 3 ml hyperbaric bupivacaine 0.5%. Results Demographic data and the quality of sensory and motor block were comparable between groups. At 5th, 10th minutes post SA; systolic, diastolic and mean arterial pressures were statistically significant higher in D group. At 20th minutes post SA; the obtained blood pressure readings and heart rate changes didn’t show any statistically significance between groups. The need for ephedrine and side effects were statistically significant lower in D group than C group. Conclusion Post-spinal anesthesia hypotension, nausea, vomiting and shivering in elderly patients were less common after receiving a single preoperative dose of dexamethasone 8 mg IVI than control. Registration number ClinicalTrials.gov Identifier: NCT 03664037, Registered 17 September 2018 - Retrospectively registered, http://www.ClinicalTrial.gov

Postspinal anesthesia shivering in lower abdominal and lower limb surgeries: a randomized controlled comparison between paracetamol and dexamethasone

“…On the other hand, our results coincided with the studies evaluating the efficacy of dexamethasone whether IV [ 11 , 14 , 29 ] or intrathecally [ 4 , 10 ] when it was added to bupivacaine in decreasing the mean time to peak sensory block level and increasing both the time to two-segment regression and the mean time to requirement of the first rescue analgesia. There was a significant attenuation of PSA hypotension in D group which could be explained by the beneficial effects of increasing peripheral vascular resistance (PVR) by a variety of mechanisms and its anti 5HT 3 effects which might influence the Bezold Jarish reflex (BJR) [ 16 ].…”

“…Despite that, the research team demonstrated that paracetamol and dexamethasone attenuated the effect of high levels of spinal blockade which decreased the core temperature threshold for shivering [ 30 ]. Moreover, dexamethasone demonstrated beneficial responses to avoid the methods that are used to avoid the PSA hypotension (e.g., volume loading or vasopressor administration) which may add the risk of hypervolemia and/or myocardial ischemia [ 16 ]. Third, this study lacked warmed intravenous fluids.…”

“…Randomization of the patients was performed using a computer-generated random numbers concealed in sealed opaque envelopes and a nurse randomly chose the envelope that determined the group of assignment [ 16 ]. Patients were allocated into three equal groups (100 each) with 1:1:1 ratio according to shivering prophylaxis; Paracetamol (P) group:( n = 100) each patient received 1 g paracetamol tablet orally with sips of water and 100 ml 0.9% sodium chloride (normal saline [NS]) (IVI) over 15 min as a placebo for dexamethasone solution; dexamethasone (D) group: ( n = 100) each patient received a placebo tablet identical to paracetamol tablet orally with sips of water and dexamethasone 8 mg ampoule diluted in 100 ml 0.9% NS IVI over 15 min; Control (C) group: ( n = 100) each patient received a placebo tablet identical to paracetamol tablet orally with sips of water and 100 ml 0.9% NS IVI over 15 min as a placebo for dexamethasone solution 2 h preoperatively.…”

“…The attending anesthesiologists, surgeons and patients were blinded to the patients’ groups assignments. All follow up notes were recorded by anesthesia residents who followed-up the patients and were unaware of the nature of medications and were not involved in any other part of the study [ 16 ].…”

Comparative analysis of effects of three different doses of fentanyl and standard dose of bupivacaine on a spinal block in patients with hip endoprosthesis surgery

“…During a spinal anaesthesia there are many side effects as a result of sympatical nervous system blockade. Post spinal anesthesia hypotension is caused by the decrease in the sympathetic outflow causing arterial vasodilatation, a decrease in venous return and consequently the activation of the Bezold Jarish reflex that elicts a triad of bradycardia, vasodilatation and further hypotension [6]. The incidence of hypotension during the spinal anesthesia is about 16% to 33% [7].…”