Spinal anesthesia-induced hypotension is caused by a decrease in stroke volume in elderly patients

Abstract

Background: Hypotension is common during spinal anesthesia (SA) and is caused by a decrease in systemic vascular resistance (SVR) and/or cardiac output (CO). The effect of the dose of bupivacaine administered intrathecally on the changes in CO in elderly patients is largely unknown. This study investigated the hemodynamic effect of SA in elderly patients by studying the effect of two different dosages of intrathecal bupivacaine.

Methods: This prospective cohort study included 64 patients aged >65 years scheduled for procedures under SA; the patients received either 15 mg bupivacaine (the medium dose [MD] group) or 10 mg bupivacaine and 5 μg sufentanil (the low dose [LD] group). Blood pressure and CO were monitored throughout the procedure using Nexfin™, a noninvasive continuous monitoring device using a finger cuff.

Results: Thirty-three patients received MD and 31 received LD and there was no mean difference in baseline hemodynamics between the groups. On an average, the CO decreased 11.6% in the MD group and 10.0 % in the LD group. There was no significant change in SVR. Incidence of a clinically relevant decrease in stroke volume (SV) (>15% from baseline) was 67% in the MD and 45% in the LD groups (P<0.05).

Conclusion: CO and blood pressure decreased significantly after the onset of SA in elderly patients. This is mainly caused by a decrease in SV and not by a decrease in SVR. There was no difference in CO and blood pressure change between dosages of 10 or 15 mg bupivacaine.

Keywords: cardiac output; dose; finger blood pressure measurement; intrathecal anesthesia; local anesthetics.

Figure 1

Flow diagram of trial procedure. Note: The patients with >1 L blood loss were excluded. Abbreviations: LD, low dose; MD, medium dose.

Figure 2

Change of SV in the MD and LD groups at 10, 20, and 30 minutes after SA. Notes: Baseline values are represented as 100%, white boxes represent MD, gray boxes represent LD, and the dots represent outliers. Abbreviations: LD, low dose; MD, medium dose; SA, spinal anesthesia; SV, stroke volume.