Colloids vs crystalloids as prehydration regimen before spinal anaesthesia in elderly normotensive and hypertensive patients

Colloids vs crystalloids as prehydration regimen before spinal anaesthesia in elderly normotensive and hypertensive patients Papagiannopoulou PK, Meitanidou MN, Georgiadou ThI, Kostoglou ChS, Georgiou M, Kanakoudis F This study was undertaken to investigate the efficacy of prehydration with crystalloids or colloids for preventing spinal anaesthesia-induced hypotension in elderly normotensive and hypertensive patients. Eighty physical status ASA I-III elderly patients were enrolled in this study, receiving spinal anesthesia. Forty consecutive normotensive patients randomly assigned to receive fluid preloading 5ml kg i.v either crystalloid (Group N/RL, n=20) or colloid solution (Group N/Coll, n=20), and forty consecutive hypertensive patients were treated in similar manner (Group H/RL, n=20, Group H/Coll, n=20). Systolic (SAP) and diastolic (DAP) arterial pressure were recorded before fluid preloading (T1-baseline), before spinal anesthesia (T2), 10min (T3), 30 min (T4) and 60 min (T5) after local anesthetic’s spinal administration. SAP and DAP decreased significantly (p<0.05 p<0.01) at T4, T5 interval compared to baseline in all groups. In hypertensive patients reduction of SAP and DAP was greater with crystalloids. In normotensive patients significant reduction of SAP and DAP was noted at T4, T5 interval, but it was similar for both regimens. Conclusions: Fluid pretreatment with 5ml/kg crystalloids or colloids did not prevent the incidence of hypotension after spinal anesthesia. Colloid prehydration seems to moderate this kind of hypotension compared to crystalloid solution in hypertensive patients. Spinal anesthesia often causes hypotension due to sympathetic blockade. More than 30% of the patients undergoing spinal anesthesia develop intraoperatively hypotension[1]. This complication is more hazardous in elderly patients, as they may have decreased physiological reserve and compromised blood supply to vital organs. Additionally, spinal induced hypotension is a particularly important issue in patients with cardiovascular disease such as hypertension, because their risk of ischemia secondary to hypotension is thus increased[2]. Several approaches to treatment have been advocated[3]. Preloading with crystalloids for the prevention of spinal anesthesia induced hypotension has gained widespread acceptance since the late 1960s[4,5]. In general, the use of crystalloids Anaesthesiology Department General Hospital of Thessaloniki “G. Gennimatas” © 2006 Society of Anesthesiology and Intensive Medicine of Northern Greece © 2006 Εταιρεία Αναισθησιολογίας και Εντατικής Ιατρικής Βορείου Ελλάδος The Greek E-Journal of Perioperative Medicine 2006; 4:66-72 (ISSN 1109-6888) www.anesthesia. gr/ejournal Ελληνικό Περιοδικό Περιεγχειρητικής Ιατρικής 2006; 4;66-72 (ISSN 1109-6888) www.anesthesia. gr/ejournal 67 requires a larger volume than colloid and this might cause pulmonary oedema in at high-risk patient, although one study found not to be the case[3]. Volume prehydration may reduce the incidence of spinal induced hypotension compared to no prehydration[6] but does not reliably prevent it[7] and the efficacy of iv fluids preloading to support arterial pressure during regional anesthesia has been queried especially in an ageing population[8]. Reports in elderly patients have shown, that crystalloid intravascular administration had no effect on spinalinduced hypotension while crystalloid, colloids or no prehydration did not reduced the incidence of hypotension[7]. The present study was undertaken to compare the influence of fluid preloading with a fixed volume of crystalloids or colloids in order to prevent hypotension after spinal anesthesia in normotensive and hypertensive elderly patients.