Hemodynamic Effects of Continuous Spinal Anesthesia in Patient Aged Over 65 Years
Condition: Hemodynamic Instability
Study type: Interventional

Summary: 
      Compared to single-dose spinal anesthesia, continuous spinal anesthesia using small titrated
      doses of local anesthetic, was safe, efficient and provided better hemodynamic profile in
      elderly patients.

      The aim of this study was to investigate the hemodynamic effects of continuous spinal
      anesthesia in elderly patients undergoing knee arthroplasty.

      Investigators use the FloTrac sensor/Vigileo haemodynamic monitoring system to assess
      modification blood pressure, stroke volume and cardiac output during anesthesia and specialy
      after every bolus of spinal anesthesia, after inflating the tourniquet and after putting it
      off.

      they recorded number of hypotension episodes, ephedrine bolus and consumption until 2 hours
      after the end of surgery.
    

Detailed description: 
      The aim of this study was to investigate the hemodynamic effects of continuous spinal
      anesthesia (CSA) in elderly patients undergoing knee arthroplasty.

      Inclusion criteria:

      Adult patients, aged more than 65 years scheduled for elective total knee arthroplasty under
      regional anesthesia.

      Study Design :

      Patients had a transthoracic echocardiography one to three months before the surgical
      procedure, performed by a cardiologist.

      An oral intake of 250 ml of water was taken 2 hours before surgery. In the operating room,
      patients received monitoring with electrocardiogram, pulse oximetry and had their blood
      pressure measured and recorded via an indwelling radial arterial catheter putting under local
      anesthesia.

      This catheter was connected to the FloTrac sensor/Vigileo haemodynamic monitoring systeme to
      track continuously stroke volume and cardiac output.

      All patients were given nasal oxygen during all the procedure to keep oxygen saturation > 95
      %. Fluid therapy was limited to 4 ml/kg/h until tourniquet release.

      Subarachnoid puncture was performed with a 19-Gauge Tuohy needle at the L3-S1 interspace
      using a midline approach. Three cm of a 22-Gauge catheter was introduced through the needle.
      An initial dose of 2,5 mg isobaric 0,5% bupivacaine was injected through the catheter.
      Additional 2,5 mg isobaric 0,5% bupivacaine doses were injected every 10 minutes until
      sensory blockade reached T10.

      Ephedrine 6 to 9 mg was given if systolic arterial pressure < 90 mmHg or < 100 mmHg with
      clinical signs of poor tolerance (dizziness, anxiety, dyspnea, vomiting).

      Sample size We included 20 patients in this observational study.
    

Intervention name(s): FloTrac sensor/Vigileo
Intervention type(s): Diagnostic Test
Intervention description(s): blood pressure (systolic, diastolic and mean), stroke volume cardiac output ephedrine consumption after bupivacaine continuous spinal anesthesia
Intervention model: Single Group Assignment
Intervention model description: The aim of this study was to investigate the hemodynamic effects of continuous spinal anesthesia in elderly patients. An oral intake of 250 ml of water was taken 2 hours before surgery.
Radial arterial catheter was putted under local anesthesia and connected to the FloTrac sensor/Vigileo haemodynamic monitoring system.
Fluid therapy was limited to 4 ml/kg/h until tourniquet release.
Subarachnoid puncture was performed at the L3-S1 interspace. An initial dose of 2,5 mg isobaric 0,5% bupivacaine was injected. Additional 2,5 mg isobaric 0,5% bupivacaine doses were injected every 10 minutes until sensory blockade reached T10.
Ephedrine 6 to 9 mg was given if systolic arterial pressure < 90 mmHg. Investigators measured blood pressure (systolic, diastolic and mean), stroke volume and cardiac output every 5 minutes from beginning of the operation and until 2 hours after the end.
Number of hypotension episodes and ephedrine consumption were noted.
Masking: None (Open Label)
Primary purpose: Diagnostic
Keywords: elderly spinal anesthesia