Protected pharmacological control of haemodynamics during spinal anaesthesia for hip fracture surgery in elderly coronarian patients

C. Rusan¹, I. Acalovschi², Adela Onuţu¹, D. Lucaciu³, S. Hopulele³, Teodora Mocan¹
1) Clinica de Ortopedie şi Traumatologie. 2) Clinica de Anestezie şi Terapie Intensivă Cluj, Centrul de Excelenţă ATI. 3) Catedra de Ortopedie şi Traumatologie a Universităţii de Medicină şi Farmacie „Iuliu Haţieganu”, Cluj-Napoca

Abstract

Background. Ephedrine is a vasopressor with mixed  and -adrenergic effects. It is efficient and extensively administered for haemodynamic control in spinal anesthesia. The -adrenergic effect is followed by tachycardia, increased myocardial contractility and oxygen consumption. This effect is not desirable in elderly patients with ischaemic heart disease. We attempted to diminish the -effect of ephedrine and to maintain the -adrenergic effect by a combined ephedrine-metoprolol administration. The aim of this study was to compare the efficiency and safety of ephedrine versus ephedrine with metoprolol, for haemodynamic control during spinal anesthesia in elderly patients (over 80) with coronary disease or atrial fibrilation submitted to hip fracture surgery.

Material and method. The study comprised 60 patients divided into three groups: group 1 who received 5 mg ephedrine; group 2 who received 5 mg ephedrine + 0.1 mg metoprolol and group 3 who received 5 mg ephedrine + 0.2 mg metoprolol. The administration of drugs started 4-5 min after spinal anaesthesia and was repeated to maintain the mean blood pressure (MBP), at least 90% of the preoperative values.

Results. The association of metoprolol with ephedrine during spinal anaesthesia maintained the MBP, avoided tachycardia and the destabilization of a chronic atrial fibrilation and reduced significantly the frequency of precordial pain and ischaemic events on ECG.

Key words: elderly, coronary disease, hip fracture, spinal anesthesia, ephedrine, metoprolol

Susţinerea farmacologică protejată a hemodinamicii în anestezia subarahnoidiană pentru chirurgia traumatismelor şoldului la vârstnicii coronarieni

Jurnalul Român de Anestezie Terapie intensivă 2005 Vol.12 Nr.2, 99-106