Pascal Meuret1, Lionel Bouvet2, Benoit Villet1, Mohamed Hafez3, Bernard Allaouchiche2, Emmanuel Boselli2,4. 1. Hospices Civils de Lyon, Édouard Herriot Hospital, Department of Anesthesiology, Lyon, France. 2. University of Lyon, University Claude Bernard Lyon I, APCSe Vetagro Sup UPSP 2016. A101, Marcy-l'Étoile, France. 3. Hospices Civils de Lyon, Édouard Herriot Hospital, Department of Orthopedic Surgery, Lyon, France. 4. Groupement Hospitalier Nord Dauphiné, Pierre Oudot Hospital Center, Department of Anesthesiology, Bourgoin-Jallieu, France.
Abstract
OBJECTIVE: Intraoperative hypotension during hip fracture surgery is frequent in the elderly. No study has compared the haemodynamic effect of hypobaric unilateral spinal anaesthesia (HUSA) and standardised general anaesthesia (GA) in elderly patients undergoing hip fracture surgical repair. METHODS: We performed a prospective, randomised open study, including 40 patients aged over 75 years, comparing the haemodynamic effects of HUSA (5 mg isobaric bupivacaine with 5 μg sufentanil and 1 mL sterile water) and GA (induction with etomidate/remifentanil and maintenance with desflurane/remifentanil). An incidence of severe hypotension, defined by a decrease in systolic blood pressure of >40% from baseline, was the primary endpoint. RESULTS: The incidence of severe hypotension was lower in the HUSA group compared with that in the GA group (32% vs. 71%, respectively, p=0.03). The median [IQR] ephedrine consumption was lower (p=0.001) in the HUSA group (6 mg, 0-17 mg) compared with that in the GA group (36 mg, 21-57 mg). Intraoperative muscle relaxation and patients' and surgeons' satisfaction were similar between groups. No difference was observed in 5-day complications or 30-day mortality. CONCLUSION: This study shows that HUSA provides better haemodynamic stability than GA, with lower consumption of ephedrine and similar operating conditions. This new approach of spinal anaesthesia seems to be safe and effective in elderly patients undergoing hip fracture surgery.
OBJECTIVE: Intraoperative hypotension during hip fracture surgery is frequent in the elderly. No study has compared the haemodynamic effect of hypobaric unilateral spinal anaesthesia (HUSA) and standardised general anaesthesia (GA) in elderly patients undergoing hip fracture surgical repair. METHODS: We performed a prospective, randomised open study, including 40 patients aged over 75 years, comparing the haemodynamic effects of HUSA (5 mg isobaric bupivacaine with 5 μg sufentanil and 1 mL sterile water) and GA (induction with etomidate/remifentanil and maintenance with desflurane/remifentanil). An incidence of severe hypotension, defined by a decrease in systolic blood pressure of >40% from baseline, was the primary endpoint. RESULTS: The incidence of severe hypotension was lower in the HUSA group compared with that in the GA group (32% vs. 71%, respectively, p=0.03). The median [IQR] ephedrine consumption was lower (p=0.001) in the HUSA group (6 mg, 0-17 mg) compared with that in the GA group (36 mg, 21-57 mg). Intraoperative muscle relaxation and patients' and surgeons' satisfaction were similar between groups. No difference was observed in 5-day complications or 30-day mortality. CONCLUSION: This study shows that HUSA provides better haemodynamic stability than GA, with lower consumption of ephedrine and similar operating conditions. This new approach of spinal anaesthesia seems to be safe and effective in elderly patients undergoing hip fracture surgery.
Authors: Mark D Neuman; Jeffrey H Silber; Nabil M Elkassabany; Justin M Ludwig; Lee A Fleisher Journal: Anesthesiology Date: 2012-07 Impact factor: 7.892
Authors: Miklos D Kertai; Ben J A Palanca; Nirvik Pal; Beth A Burnside; Lini Zhang; Furqaan Sadiq; Kevin J Finkel; Michael S Avidan Journal: Anesthesiology Date: 2011-03 Impact factor: 7.892