Hypotension from spinal anesthesia in patients aged greater than 80 years is due to a decrease in systemic vascular resistance

Nakasuji, Masato; Suh, Soon Hak; Nomura, Masataka; Nakamura, Mai; Imanaka, Norie; Tanaka, Masuji; Nakasuji, Kae

doi:10.1016/j.jclinane.2011.07.014

Cited by 31 publications

(18 citation statements)

References 29 publications

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“…In elderly patients, spinal hypotension is caused predominantly by decrease in the systemic vascular resistance than a decrease in cardiac output,[20] in younger patients systemic vascular resistance decreases to lesser extent for the same level of spinal block. [21] This causes more elderly patients requiring treatment than young.…”

Section: Discussionmentioning

confidence: 99%

Clonidine as an adjuvant to hyperbaric bupivacaine for spinal anesthesia in elderly patients undergoing lower limb orthopedic surgeries

et al. 2014

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Background:In elderly patients, use of adjuvant with small doses of local anesthetics is a preferred technique for spinal anesthesia for lower limb surgeries. This study tested the hypothesis that addition of small doses of clonidine augments the spinal block levels produced by hyperbaric bupivacaine in elderly without affecting the side-effects if any of clonidine in these patients.Materials and Methods:This was a prospective, randomized, double-blind study. Above 60 years male patients were allocated to three equal groups. Group C received 9 mg hyperbaric bupivacaine without clonidine while Group C15 and Group C30 received 15 μg and 30 μg clonidine with hyperbaric bupivacaine respectively for spinal anesthesia. Effect of clonidine on sensory block levels was the primary study outcome measure. Motor blockade and hemodynamic parameters were also studied.Results:A significantly higher median block levels were achieved in Group C15 (P < 0.001) and Group C30 (P = 0.015) than Group C. Highest median sensory block level, the mean times for sensory regression to T12 level and motor block regression were statistically significant between Groups C15 and C and between Groups C30 and C. On comparison of fall in systolic blood pressure trends, there was no significant difference in the clonidine groups as compared with the control group.Conclusions:In elderly patients, clonidine when used intrathecally in doses of 15 μg or 30 μg with bupivacaine, significantly potentiated the sensory block levels and duration of analgesia without affecting the trend of systolic blood pressure as compared to bupivacaine alone. Clonidine in doses of 30 μg however facilitated the ascent of sensory level block to unexpectedly higher dermatomes for a longer time.

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Section: Discussionmentioning

confidence: 99%

Clonidine as an adjuvant to hyperbaric bupivacaine for spinal anesthesia in elderly patients undergoing lower limb orthopedic surgeries

et al. 2014

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“…2 Whilst there have been very few studies in spontaneously breathing patients, a volunteer study revealed that PVI decreased with straight leg raising. 3 As stroke volume variation is known to increase during spinal anaesthesia, 4 we hypothesized that this would also be the case for PVI and that this rise could be used to identify the onset of hypotension.…”

Section: Changes In Pleth Variability Index and Detection Of Hypotensmentioning

confidence: 99%

Changes in pleth variability index and detection of hypotension during spinal anaesthesia for caesarean section

Wrench

Hammon

Handa

et al. 2015

International Journal of Obstetric Anesthesia

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“…The majority of studies on haemodynamic changes in spinal anaesthesia were performed on elderly (above 60 years of age) and parturient, however their haemodynamic status may be influenced by other factors. Elderly patients have higher decreases in systemic vascular resistance during spinal anaesthesia compared to young patients, (24,25) some authors consider it as the main mechanism of hypotension in elderly, (26) besides this, in the aged heart there is less of a compensatory increase in heart rate and contractility (decreased beta-adrenergic responsiveness), therefore a compensatory increase in cardiac output is smaller than in young adults or there is even a decrease in CO. On the other hand, the basal haemodynamic status of a healthy pregnant woman is characterized by a decrease in SVR, an increase in total blood volume and CO (27) and because of lower vascular tone, more blood volume is trapped in extremities. (28) Besides this, pregnant women are more susceptible to the effects of the sympathetic block.…”

Section: Introductionmentioning

confidence: 99%

Comparison of haemodynamic parameters between the high and low spinal block in young healthy patients

Poredoš¹,

Novak-Jankovič²

2017

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Background. For some surgical procedures a higher sensory block is needed. However, it is complicated by a higher incidence of hypotension, more bradycardia and nausea and a higher use of vasoactive drugs. In elderly and obstetric population complications have been attributed to the decrease in cardiac output and systemic vascular resistance, especially in a high block (above Th6). The aim of our study was to find the incidence of hypotension and bradycardia after a spinal anaesthesia in young, healthy patients. As young patients compensate more, we aimed to find the difference in haemodynamic variables between the group with a high and the group with a low spinal block and the underlying mechanisms of hypotension. Methods. In a prospective, randomized study 44 American Society of Anaesthesiologists (ASA) 1 patients scheduled for knee arthroscopy under spinal anaesthesia were randomly distributed to a high (group H) and a low (group L) spinal block group. In a group H patients were placed into horizontal, whereas in a group L in 15-degree anti-Trendelenburg position immediately after the spinal block. Haemodynamic parameters were measured continuously noninvasively from 10 min before to 25 min after the spinal block using the CNAPTM device with the LiDCORapid monitor. Results. The differences in haemodynamic parameters between the groups were not statistically significant at all measured times despite a significant difference in the spinal block level (18.5 vs 13.3 dermatomes above S5, p<0.001) and a significant difference in haemodynamic variables

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Hypotension from spinal anesthesia in patients aged greater than 80 years is due to a decrease in systemic vascular resistance

Cited by 31 publications

References 29 publications

Clonidine as an adjuvant to hyperbaric bupivacaine for spinal anesthesia in elderly patients undergoing lower limb orthopedic surgeries

Clonidine as an adjuvant to hyperbaric bupivacaine for spinal anesthesia in elderly patients undergoing lower limb orthopedic surgeries

Changes in pleth variability index and detection of hypotension during spinal anaesthesia for caesarean section

Comparison of haemodynamic parameters between the high and low spinal block in young healthy patients

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