PREVENTION OF SPINAL ANESTHESIA-INDUCED HYPOTENSION IN THE ELDERLY - COMPARISON BETWEEN PREANESTHETIC ADMINISTRATION OF CRYSTALLOIDS, COLLOIDS, AND NO PREHYDRATION

The practice of routinely prehydrating patients by infusing a crystall oid or colloid solution (up to 1.0 L/70 kg) for prevention of spinal a naesthesia-induced hypotension has been challenged recently, after sev eral reports of failure to demonstrate its efficacy in young women. We compared the incidence and frequency of hypotension and vasopressor t herapy after spinal anesthesia and no prehydration with crystalloid an d colloid prehydration in elderly patients. Eighty-five ASA grade I or II patients (aged 60-89 yr) for elective total hip replacement were r andomized to receive 500 mL crystalloid solution (Hartmanns(TM), n = 2 9), 500 mL colloid (Haemaccel(TM), n = 28), or no prehydration (n = 28 ) over 10 min prior to spinal anesthesia. Hypotension was defined as a 30% decrease from baseline systolic blood pressure (BP) or systolic < 90 mm Hg, and was treated with ephedrine 3-mg boluses. Although absolu te systolic BP readings were significantly higher in the colloid group between 6 and 30 min (P < 0.05), the incidence of hypotension was not significantly different between the groups. The incidence of ephedrin e use, incidence of nausea/vomiting, and median total dose of ephedrin e were similar in all groups. We conclude that, in elderly patients un dergoing elective procedures, withholding prehydration is not associat ed with any greater degree of hypotension or need for vasopressor ther apy compared with crystalloid or colloid prehydration.