HEMODYNAMIC-EFFECTS OF SPINAL-ANESTHESIA IN THE ELDERLY - SINGLE-DOSEVERSUS TITRATION THROUGH A CATHETER

Sixty elderly patients (> 70 yr old) undergoing surgery for hip fractu re were prospectively studied in order to compare hemodynamic toleranc e of titrated doses of hyperbaric bupivacaine using continuous spinal anesthesia (CSA) versus single-dose spinal anesthesia (SDSA). Patients were randomized into two groups (CSA group: n = 30; SDSA group: n = 3 0). The SDSA patients received 10-15 mg of 0.5% hyperbaric bupivacaine (based on age and height), and the CSA patients received a starting d ose of 5 mg of 0.5% hyperbaric bupivacaine, followed after 15 min by o ptional reinjection of 2.5 mg every 5 min until a T10 level sensory bl ock was reached. Onset of anesthesia, noninvasive hemodynamic variable s and the need for ephedrine were studied for 4 h after induction of a nesthesia. Spinal anesthesia was successful in all patients. Decreases in mean arterial pressure were significantly less frequent and less p ronounced in the CSA group (19.9% +/- 1.6% of the baseline value) than in the SDSA group (40.2% +/- 1.9%, P < 0.0001). The mean dose of ephe drine was significantly less in the CSA group (1.8 +/- 0.7 mg, adminis tered to only 37% of patients) than in the SDSA group (19.4 +/- 3.3 mg administered to all patients, P < 0.0001). No late complications rela ted to the spinal anesthesia technique were observed in either group. We concluded that CSA, using small titrated doses of 0.5% hyperbaric b upivacaine, is safe, efficient, and provides better hemodynamic stabil ity than SDSA in elderly patients.