The influence of the infusion of ephedrine and phenylephrine on the hemodynamic stability after subarachnoid anesthesia in senior adults - a controlled randomized trial

Miodrag Žunić,Nevenka Krčevski Škvarč,Mirt Kamenik

doi:10.1186/s12871-019-0878-4

Miodrag Žunić, Nevenka Krčevski Škvarč + Show 1 more

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https://doi.org/10.1186/s12871-019-0878-4

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Journal: BMC anesthesiology	Publication Date: Nov 11, 2019
Citations: 7	License type: open-access

Affiliation: University Clinical Centre Maribor

Abstract

BackgroundWe studied the influence of ephedrine or phenylephrine infusion administered immediately after spinal anesthesia (SA) on hemodynamics in elderly orthopedic patients.MethodsA prospective, randomized, double-blind, placebo-controlled study.After a subarachnoid injection of 15 mg of levobupivacaine, the participants received an infusion of either ephedrine 20 mg (E group), phenylephrine 250 mcg (P group) or saline (C group) within 30 min. We measured blood pressure, cardiac index (CI) and heart rate (HR) from 15 min before to 30 min after SA.ResultsSeventy patients were included in the final analysis. At the end of measurements, mean arterial pressure (MAP) decreased significantly after SA in comparison to the baseline value in the C group but was maintained in the P and E group, with no significant differences between the groups. CI decreased after SA in the C group, was maintained in the P group, and increased significantly in the E group with significant differences between the C and E group (p = 0.049) also between the P and E (p = 0.01) group at the end of measurements. HR decreased significantly after SA in the C and P group but was maintained in the E group, with significant differences between the P and E group (p = 0.033) at the end of measurements.ConclusionsHemodynamic changes after SA in elderly orthopedic patients can be prevented by an immediate infusion of phenylephrine or ephedrine. In addition to maintaining blood pressure, the ephedrine infusion also maintains HR and increases CI after SA.Trial registrationISRCTN registry with registration number ISRCTN44377602, retrospectively registered on 15 June 2017.

Highlights

According to the national arthroplasty registers of many European countries, England, Australia and Canada, the prevalence of the hip and knee arthroplasty has increased in number over the past decades [1, 2, 3, 4]
Hemodynamic changes after spinal anesthesia (SA) in elderly orthopedic patients can be prevented by an immediate infusion of phenylephrine or ephedrine
Our study shows that we can decrease the incidence of complications and the decrease in MAP after SA with the combination of the Ringers solution infusion with the infusion of ephedrine or an infusion of phenylephrine

Summary

Introduction

According to the national arthroplasty registers of many European countries, England, Australia and Canada, the prevalence of the hip and knee arthroplasty has increased in number over the past decades [1, 2, 3, 4]. The available data from European registers shows the mean age at hip replacement surgery varied between 64 years in Romania and 71 years in Germany. The mean age at surgery varied between 66 years in Slovakia and 72 years in Catalonia. The incidence of SA-induced hypotension (SAIH) in the elderly is almost 80% [9] and is due to a decrease of both the systemic vascular resistance (SVR) as well as cardiac output (CO) [5]. The elderly are at high risk for hypoperfusion caused by hypotension, because of the high incidence of comorbid conditions [5, 13, 14]. Ephedrine is a direct and indirect α in β-receptor agonist. Phenylephrine is a direct α1-receptor agonist with a known beneficial effect during SA for the cesarean delivery [5, 18,19,20,21]

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