Haemodynamic stability by association of ephedrine with metoprolol during spinal anaesthesia for trauma surgery of the lower limb in elderly coronarian patients

S. Bâldea1, L. Szegedi2

1. Secţia ATI, Spitalul Judeţean Buzău
2. Clinica ATI, Spitalul Clinic Judeţean de Urgenţă Orade

Abstract

Background. Ephedrine is efficient and extensively administrated for haemodynamic control during spinal anaesthesia. It is a vasopressor with α and β-adrenergic effects. The β-adrenergic effects may produce tachycardia end oxygen consumption, unfavourable in patients with coronary disease. The aim of this study was to compare the efficiency and safety of ephedrine versus ephedrine plus metoprolol for haemodynamic control in elderly patients (over 70 yrs) with coronary disease associated or not with atrial fibrillation during spinal anaesthesia for trauma surgery of the lower limb. Statistical analysis was performed using ANOVA test and the chi square test, p < 0.05 indicated a statistical significance
Material and method. The study included 40 patients divided in two groups: group 1 - received 5 mg ephedrine; group 2 - received 5 mg ephedrine plus 0.1 mg metoprolol. The administration of drugs started after the onset of spinal anaesthesia and was repeated to maintain the systolic blood pressure at least at 85-90% of the preoperative values.
Results. The association of metoprolol and ephedrine during spinal anaesthesia maintained the mean blood pressure at 85-90% of the preoperative values. It avoided tachycardia and the destabilization of a chronical atrial fibrillation and reduced significantly the frequency of precordial pain and of the ischaemic events on ECG.
Key words: elderly, coronary disease, spinal anaesthesia, ephedrine, metoprolol, lower limb surgery

Stabilitate hemodinamică prin asocierea efedrină-metoprolol în anestezia subarahnoidiană pentru chirurgia traumatică a membrului inferior la vârstnicii coronarieni

Jurnalul Român de Anestezie Terapie intensivă 2007 Vol.14 Nr.2, 81-86