Hemodynamic Profile of Target-Controlled Spinal Anesthesia Compared With 2 Target-Controlled General Anesthesia Techniques in Elderly Patients With Cardiac Comorbidities

Abstract

In elderly patients, spinal anesthesia using titrated doses of bupivacaine provided better blood pressure stability than propofol or sevoflurane anesthesia.

Optimal perioperative management of arterial blood pressure

“…It allows incremental dosing of local anesthetics and can safely be used in patients with cardiac diseases 73. Continuous spinal anesthesia provides better blood pressure stability than general anesthesia (with propofol or sevoflurane) in elderly patients with hip fractures 74. Nevertheless, low doses of local anesthetics may compromise anesthetic efficacy 75.…”

Single shot spinal anesthesia with very low hyperbaric bupivacaine dose (3.75mg) for hip fracture repair surgery in the elderly. A randomized, double blinded study

“…In old patients general anesthesia is not a guarantee of cardiovascular balance. 17 Continuous spinal anesthesia has been used in old patients, 18,19 but slow incremental sensory block, more incidence of paresthesias, large gauge catheters inserted into the dural sac, are among the drawbacks of this technique. Moreover, some studies reported that the total local anesthetic dose administered is almost the same as in the SSA, with no hemodynamic advantages and additional technical difficulties.…”

“…Compared with general anesthesia, regional anesthesia, including SSA, has been related with lower incidence of severe complications and mortality as showed in several metaanalyses. 17,26,27 Postoperative cognitive disorders and delirium are frequent in in-hospital elderly patients, and increase when submitted to surgical procedures and other circumstances including drugs and general anesthesia. 2,28---31 The use of very low doses of local anesthetics in the SSA technique, as we propose, can prevent or minimize arterial hypotension.…”

Single shot spinal anaesthesia with hypobaric bupivacaine for hip fracture repair surgery in the elderly. Randomized, double blinded comparison of 3.75mg vs. 7.5mg

“…General anaesthesia 27 No decrease in incidence. Postoperative cognitive disorders and delirium increase when submitted to surgical procedures and drugs and general anaesthesia 4,29,30,54,55 Continuous spinal anaesthesia 44,50---52 Slow incremental sensory block level; more incidence of paresthesias; large bore catheters; total local anaesthetic dose could be almost the same as in the SSA or higher, additional technical difficulties Incremental epidural anaesthesia 47 Sensory and motor block of low quality, long time required to start surgery; systemic toxicity due to high volume-dose of local anaesthetic Combined spinal-epidural anaesthesia 53 Most time consuming, is use to be unnecessary to use the epidural catheter due to the short duration of surgery and well controlled postop pain with NSAID's and systemic opiates Rapid infusion of fluids and prophylactic vasopressors…”