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

• Published in: Local and regional anesthesia 2019-03, Vol.12, p.19-26
• Main Authors: Hofhuizen, Charlotte, Lemson, Joris, Snoeck, Marc, Scheffer, Gert-Jan
• Format: Article
• Language: English
• Subjects: Anesthesia; Anesthetics; Blood pressure; Blood pressure measurement; Bupivacaine; Cardiac arrhythmia; cardiac output; dose; Elderly patients; finger blood pressure measurement; Heart rate; Hydroxyethyl starch; Intensive care; intrathecal anesthesia; local anesthetics; Medical research; Original Research; Oxazepam; Patients; Pressure measurement; Sepsis; Statistics; Sufentanil; Systematic review; Vascular surgery
• ISSN: 1178-7112; 1178-7112
• DOI: 10.2147/LRA.S193925

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. 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. 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 (