Dexamethasone blunts postspinal hypotension in geriatric patients undergoing orthopedic surgery: a double blind, placebo-controlled study

Tarek M Ashoor,Sherif G Anis,Noha S Hussien,Ibrahim M Esmat

doi:10.1186/s12871-021-01232-w

Tarek M Ashoor, Sherif G Anis + Show 2 more

Open Access

https://doi.org/10.1186/s12871-021-01232-w

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Journal: BMC Anesthesiology	Publication Date: Jan 11, 2021
Citations: 7	License type: open-access

Affiliation: Ain Shams University

Abstract

BackgroundPost-spinal anesthesia (PSA) hypotension in elderly patients is challenging. Correction of PSA hypotension by fluids either colloids or crystalloids or by vasoconstrictors pose the risk of volume overload or compromising cardiac conditions. Dexamethasone is used to treat conditions manifested by decrease of peripheral vascular resistance. The research team was the first to test the hypothesis of its role in preventing or decreasing the incidence of PSA hypotension.MethodsOne hundred ten patients, aged 60 years or more were recruited to receive a single preoperative dose of dexamethasone 8 mg IVI in 100 ml normal saline (D group) (55 patients) 2 h preoperatively, and 55 patients were given placebo (C group) in a randomized, double-blind trial. Variations in blood pressure and heart rate in addition to the needs of ephedrine and/or atropine following spinal anesthesia (SA) were recorded. SA was achieved using subarachnoid injection of 3 ml hyperbaric bupivacaine 0.5%.ResultsDemographic data and the quality of sensory and motor block were comparable between groups. At 5th, 10th minutes post SA; systolic, diastolic and mean arterial pressures were statistically significant higher in D group. At 20th minutes post SA; the obtained blood pressure readings and heart rate changes didn’t show any statistically significance between groups. The need for ephedrine and side effects were statistically significant lower in D group than C group.ConclusionPost-spinal anesthesia hypotension, nausea, vomiting and shivering in elderly patients were less common after receiving a single preoperative dose of dexamethasone 8 mg IVI than control.Registration numberClinicalTrials.gov Identifier: NCT 03664037, Registered 17 September 2018 - Retrospectively registered, http://www.ClinicalTrial.gov

Highlights

Post-spinal anesthesia (PSA) hypotension in elderly patients is challenging
The main cause of post spinal anesthesia (PSA) hypotension is the decrease in the sympathetic outflow causing arterial vasodilatation, a decrease in venous return and the activation of the Bezold Jarish reflex (BJR) [2] that elicits a triad of bradycardia, vasodilatation and further hypotension [3, 4]
Out of 136 patients were assessed for eligibility and 110 patients were analyzed; 55 in the D group and 55 in C group (Fig. 1)

Summary

Introduction

Post-spinal anesthesia (PSA) hypotension in elderly patients is challenging. Correction of PSA hypotension by fluids either colloids or crystalloids or by vasoconstrictors pose the risk of volume overload or compromising cardiac conditions. The main cause of post spinal anesthesia (PSA) hypotension is the decrease in the sympathetic outflow causing arterial vasodilatation, a decrease in venous return and the activation of the Bezold Jarish reflex (BJR) [2] that elicits a triad of bradycardia, vasodilatation and further hypotension [3, 4]. BJR is elicited by activation of 5HT3 receptors within the intracardiac vagal nerve endings [5]. Those effects are prominent in geriatric patients with PSA hypotension estimated to be over 70% [5]. Methods that are used to avoid the PSA hypotension (e.g., volume loading or vasopressor administration) may add the risk of hypervolemia and/or myocardial ischemia for those patients [6]

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