Hypotension induced by lateral decubitus or supine spinal anaesthesia in elderly with low ejection fraction undergone hip surgery

• Published in: Journal of clinical monitoring and computing 2007-04, Vol.21 (2), p.103-107, Article 103
• Main Authors: SEN, Selda, AYDIN, Kutlay, DISCIGIL, Guzel
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Anesthesia; Anesthesia, Spinal - adverse effects; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Arthroplasty, Replacement, Hip - adverse effects; Biological and medical sciences; Blood. Blood coagulation. Reticuloendothelial system; Bradycardia; Bupivacaine; Diabetes mellitus; Ejection fraction; Ephedrine; Female; Humans; Hypertension; Hypotension; Hypotension - etiology; Intensive care medicine; Male; Medical sciences; Older people; Patients; Pharmacology. Drug treatments; Posture; Risk Assessment - methods; Risk Factors; Segments; Stroke Volume; Supine Position; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Treatment Outcome; Ventricular Dysfunction, Left - complications; Ventricular Dysfunction, Left - diagnosis
• ISSN: 1387-1307; 1573-2614
• DOI: 10.1007/s10877-006-9062-8

The aim of the study was to assess the effect of low ejection fraction (EF) on hypotension during lateral or supine position of spinal anaesthesia in patients older than 75 years old. We analyzed 41 patients who had undergone hip surgery between August 2000 and October 2001 in the Aydin SSK State Hospital retrospectively. Patients older than 75 years of age and an EF less than 50% were selected and spinal anaesthesia was performed with hyperbaric bupivacaine 0.5%, lateral decubitus or supine position. The patients were divided into two groups: Group I (unilateral group, n = 23) and Group II (supine group, n = 18). History of hypertension, diabetes mellitus, and ASA status, preoperative value of EF and cardiac index, and intraoperative hypotension, bradycardia, ephedrine use, and maximal sensorial block levels were recorded. The age range of patients was between 75 and 103. The maximal sensorial block level was evaluated due to lower or higher than thoracic sixth segment for each patient in intraoperative period. The sensorial block level higher than thoracic sixth segment were determined 2 patient in Group I and 14 patients in Group II (p = 0.001). Hypotension was observed in five patients in Group I and 10 patients in Group II (p = 0.015). In Group I, the number of ephedrine used patient was lower than Group II (p = 0.015). Elderly patients with low EF were more likely to predispose to higher sensorial block level and hypotension was more common during spinal anaesthesia with supine position compared to lateral decubitus position.