- 作者：Masato Nakasuji ; MD ; nakasuji.masato@c3.kepco.co.jp (Specialist in Anesthesiology ; Chief Anesthesiologist) ; Soon Hak Suh ; MD (Resident in Anesthesiology) ; Masataka Nomura ; MD (Resident in Anesthesiology) ; Mitsuyo Nakamura ; MD (Staff Anesthesiologist) ; Norie Imanaka ; MD (Specialist in Anesthesiology) ; Masuji Tanaka ; MD (Specialist in Anesthesiology) ; Kae Nakasuji ; MD (Research Fellow in Anesthesiology)
- 关键词：Cardiac output ; Elderly patients ; Geriatrics ; Hip fracture ; Spinal anesthesia-induced hypotension ; Stroke volume variations ; Systemic vascular resistance
- 刊名：Journal of Clinical Anesthesia
- 出版年：2012
- 期刊代码：147_09528180
- 类别：med
- 出版时间：May, 2012
- 卷：24
- 期：3
- 页码：201-206
- 文件大小：247 K
Study Objectives
To determine the exact mechanism underlying spinal anesthesia-induced hypotension in the elderly patient.Design
Retrospective case-control study.
Setting
Operating room (OR) in a general hospital.
Measurements
Records from 60 consecutive patients over 80 years of age, who underwent hip fracture repair (intramedullary nail or compression hip screw) during spinal anesthesia were studied. After injection of isobaric 0.5%bupivacaine in the L3-L4 intervertebral space in the lateral decubitus position, patients were turned supine. Acetate Ringer鈥檚 solution (300 mL) was infused over 30 minutes after subarachnoid puncture. A decrease in systolic arterial pressure to less than 100 mmHg was treated with an intravenous injection of 5 mg ephedrine. The hypotension group (n=18) comprised patients who required ephedrine during the 30 minutes after the puncture, and the nonhypotension group (n=42) consisted of patients who maintained stable arterial pressure with crystalloid infusion only.
Measurements
Cardiac output (CO) and stroke volume variation (SVV) every 20 seconds using the Vigileo-FloTrac system continuously from arrival in the operating room (OR) to 30 minutes after the subarachnoid puncture were recorded. Serial changes in systemic vascular resistance (SVR), CO, and SVV from baseline after puncture were compared between the two groups.
Main Results
The decrease in SVR over 20 minutes after the puncture was significantly greater in the hypotension group than the nonhypotension group (P = 0.047). Cardiac output was stable in the two groups. Stroke volume variation in the first 10 minutes after the puncture increased to similar levels in the two groups, then decreased gradually to baseline. No significant differences were noted in circulatory parameters on arrival at the OR.
Conclusions
A decrease in SVR, not CO, is the main mechanism of hypotension seen during spinal anesthesia in elderly patients.