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A comparison of three fluid-vasopressor regimens used to prevent hypotension during subarachnoid anaesthesia in the elderly

Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong


We aimed to compare the efficacy of fluid preloading with two recently recommended fluid- vasopressor regimens for maintaining blood pressure during subarachnoid anaesthesia in the elderly. Sixty elderly patients requiring surgery for traumatic. hip fractures received subarachnoid anaesthesia using 0.05 ml/kg of 0.5% heavy bupivacaine. Hypotension, i.e. systolic arterial pressure <75% of baseline, was prevented or treated by: A - normal saline 16 ml/kg plus intravenous ephedrine boluses (0.1 mg/kg); B - normal saline 8 ml/kg plus intramuscular depot ephedrine (0.5 mg/kg); or C-Haemaccel 8 ml/kg plus metaraminol infusion.

Systolic arterial pressure and heart rate were recorded using (custom-written computer software (Monitor, version 1.0). Systolic arterial pressure decreased in all groups after five minutes (P <0.001). Decreases were greatest in group A (P <0.05). Heart rate increased by 7% group A and decreased by 9% in group C (P <0.05). During the first hour hypotension was present for 47%, 25% and 20% of the time in groups A, B and C respectively and overcorrection of systolic arterial pressure occurred in 19% of the time in group C

We conclude that treatment A was inadequate in preventing hypotension. Treatments B and C were more effective but were associated with an increased heart rate and overcorrection of systolic arterial pressure respectively.

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