<p>Spinal anesthesia-induced hypotension is caused by a decrease in stroke volume in elderly patients</p>

Abstract

Background Hypotension is common during spinal anesthesia (SA) and is caused by a decrease in systemic vascular resistance (SVR) and/or cardiac output (CO). The effect of the dose of bupivacaine administered intrathecally on the changes in CO in elderly patients is largely unknown. This study investigated the hemodynamic effect of SA in elderly patients by studying the effect of two different dosages of intrathecal bupivacaine. Methods This prospective cohort study included 64 patients aged >65 years scheduled for procedures under SA; the patients received either 15 mg bupivacaine (the medium dose [MD] group) or 10 mg bupivacaine and 5 μg sufentanil (the low dose [LD] group). Blood pressure and CO were monitored throughout the procedure using Nexfin™, a noninvasive continuous monitoring device using a finger cuff. Results Thirty-three patients received MD and 31 received LD and there was no mean difference in baseline hemodynamics between the groups. On an average, the CO decreased 11.6% in the MD group and 10.0 % in the LD group. There was no significant change in SVR. Incidence of a clinically relevant decrease in stroke volume (SV) (>15% from baseline) was 67% in the MD and 45% in the LD groups ( P <0.05). Conclusion CO and blood pressure decreased significantly after the onset of SA in elderly patients. This is mainly caused by a decrease in SV and not by a decrease in SVR. There was no difference in CO and blood pressure change between dosages of 10 or 15 mg bupivacaine.

Comparison of general anesthesia with endotracheal intubation, combined spinal-epidural anesthesia, and general anesthesia with laryngeal mask airway and nerve block for intertrochanteric fracture surgeries in elderly patients: a retrospective cohort study

“…In our study, patients receiving the combined spinal-epidural anesthesia also had significantly greater hemodynamic variations compared to those receiving general anesthesia with LMA and nerve block. Spinal anesthesia can inhibit the sympathetic nerves, leading to peripheral vascular dilation and hypotension [8][9][10]. In addition, vagus nerve dominance and slow heart rate during spinal anesthesia may also result in significant hemodynamic variations.…”

Anesthetic management of geriatric patients

“…In elderly patients undergoing hip fracture repair, continuous spinal anesthesia (CSA) provided fewer episodes of moderate-to-severe hypotension when compared with a single intrathecal injection of 7.5 mg bupivacaine [89]. A prospective cohort study showed that cardiac output and blood pressure decreased significantly after the onset of SA in elderly patients, mainly due to a decrease in stroke volume and not in systemic vascular resistance [90]. A 2014 prospective randomized study of elderly highrisk patients undergoing hip replacement surgery showed that CSA and psoas compartment sciatic nerve block (PCSNB) produced a satisfactory quality of anesthesia.…”

Perbandingan Efektivitas Anestesi Spinal Menggunakan Bupivakain Hiperbarik dengan Bupivakain Isobarik pada Pasien yang Menjalani Prosedur Operasi Abdomen Bagian Bawah di RSUP Dr. Kariadi

“…3 Keadaan ini disebabkan oleh karena blokade simpatis yang lebih tinggi pada bupivakain hiperbarik (T5) menyebabkan paralisis pada serabut preganglionik saraf simpatis yang kemudian mentransmisikan impuls motorik ke otot polos pembuluh darah perifer. 16,17 Arteri dan arteriol akan mengalami dilatasi pada daerah-daerah yang mengalami denervasi simpatis sehingga resistensi vaskular perifer dan tekanan arteri rata-rata akan mengalami penurunan. Terjadi dilatasi pada vena dan venule perifer dengan pengumpulan darah akan menurunkan curah balik ke jantung sehingga akan menyebabkan penurunan curah jantung dan tekanan darah.…”