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Spinal anesthesia-induced hypotension is caused by a decrease in stroke volume in elderly patients

Authors Hofhuizen C, Lemson J, Snoeck M, Scheffer GJ

Received 10 November 2018

Accepted for publication 7 January 2019

Published 4 March 2019 Volume 2019:12 Pages 19—26


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Stefan Wirz

Charlotte Hofhuizen,1 Joris Lemson,1 Marc Snoeck,2 Gert-Jan Scheffer3

1Department of Critical Care, Radboud University Medical Center, Nijmegen, The Netherlands; 2Department of Anesthesia, Canisius-Wilhelmina Ziekenhuis, Nijmegen, The Netherlands; 3Department of Anesthesia, Radboud University Medical Center, Nijmegen, The Netherlands

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.

Keywords: cardiac output, intrathecal anesthesia, local anesthetics, dose, finger blood pressure measurement

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