Intravenous ketamine for prevention of severe hypotension during spinal anaesthesia

Abstract

Spinal block causes paralysis of preganglionic sympathetic fibres, while ketamine induces activation of the sympathetic nervous system. Hypotension is a frequent complication during spinal anaesthesia and is associated with an increased risk of postoperative mortality. The aim of our study was to compare circulatory changes in patients who received either fentanyl or ketamine during spinal anaesthesia. Thirty patients (ASA I-III) scheduled to undergo spinal anaesthesia for osteosynthesis of hip fractures were allocated to receive either ketamine or fentanyl intravenously during the procedure. Immediately before anaesthesia, 7 ml/kg BW of an isotonic NaCl solution was administered i.v. Patients received either fentanyl 1.5 mg/kg BW i.v. before anaesthesia, or ketamine 0.7 mg/kg BW i.v. before anaesthesia, and 0.35 mg/kg BW 15 and 30 min after the first dose. No prophylactic vasopressor was used. During the first 40 min of anaesthesia a fluid load of 14 ml/kg BW was given i.v. If the mean arterial pressure (MAP) fell more than 20%, the infusion rate was increased. If the reduction in MAP exceeded 33% or if the systolic pressure decreased to less than 80 mmHg, patients were registered as haemodynamically unstable. In both groups the spinal anaesthesia caused a reduction in MAP. The MAP was lower in the fentanyl group than in the ketamine group at all times. In the fentanyl group six subjects developed a haemodynamically unstable condition, while only one subject in the ketamine group was registered as such (P less than 0.05). There was no significant change in heart rate in either group. We conclude that during spinal anaesthesia patients can in part be kept haemodynamically stable by intravenous administration of ketamine.