Crystalloid and colloid preload for maintaining cardiac output in elderly patients undergoing total hip replacement under spinal anesthesia

Rufeng Xie,Lizhong Wang,Hongguang Bao

doi:10.1016/s1674-8301(11)60024-9

Rufeng Xie, Lizhong Wang + Show 1 more

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https://doi.org/10.1016/s1674-8301(11)60024-9

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Abstract

The aim of the present study was to compare the effects of colloid and crystalloid preload on cardiac output (CO) and incidence of hypotension in elderly patients under spinal anesthesia (SA). A randomized, double-blinded study was conducted including 47 elderly patients undergoing scheduled total hip replacement (THR), who were randomized to three groups: the control group (C group, n = 15), crystalloid (RS group, n = 16) and colloid group (HES group, n = 16). An intravenous preload of 8 mL/kg of either lactated Ringer's solution in the RS group or 6% hydroxyethyl starch in the HES group was infused within 20 min before SA induction, while no intravenous preload was given in the C group. There was a trend of decrease in CO and systolic blood pressure after SA with time in the C group. In the RS and HES groups, CO increased significantly after fluid preloading as compared with baseline ( P < 0.01). Thereafter, CO remained higher than baseline until 30 min after SA in the HES group. The change of systolic blood pressure was similar to CO, but no significant difference from baseline was observed in each group. Hypotension occurred in 3 patients in the C group and one each in the RS and HES group, respectively ( P = 0.362). Intravascular volume preload with colloid is more effective than crystalloid solution in maintaining CO, which may be improved the hemodynamic stability in elderly patients during SA.

Highlights

Hip fracture is a common disease in the elderly and often requires surgical treatment such as total hip replacement[1,2]
A 20-gauge intravenous catheter was inserted into the forearm vein, and an intravenous preload of 8 mL/ kg of either lactated Ringer’s solution in the RS group or hydroxyethyl starch solution (6% HES 130/0.4; Voluven, Fresenius Kabi, Homburg, Germany) in the HES group was infused over 20 min before spinal anesthesia (SA) while no fluid preload was given in the C group
The present study showed that fluid preload alleviated the trend toward decrease in the cardiac output and systolic blood pressure after induction of spinal

Summary

Introduction

Hip fracture is a common disease in the elderly and often requires surgical treatment such as total hip replacement[1,2]. There are predictable physiological and metabolic changes in elderly patients that limit their ability to respond to surgical and anesthetic stress. Comorbidities such as cardiovascular disease increase with age and may contribute to perioperative adverse events and mortality[3,4,5]. Hypotension remains the most common complication after spinal anesthesia and may increase the risk of myocardial ischaemia, especially in the elderly patients[3,9,10].

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