Jakobsson J, et al. - This study offers a further prospective analysis of the previously reported observation that stroke volume is reduced in a majority of elderly patients undergoing surgical repair of hip fracture before and after intrathecal injection of anaesthetic. The following may be essential features of postspinal hypotension in elderly patients: a decrease in cardiac output from baseline before spinal anaesthesia and an inability to increase it after induction.

Methods

• This study included patients ≥65 yr undergoing elective arthroplasty, who were monitored with LiDCOplus preoperatively (baseline), before and continuously for 45 min after spinal anaesthesia.
• Postspinal hypotension was defined as systolic blood pressure (bp) < 100 mm Hg or > 30% decrease from baseline.
• Using logistic regression analysis, researchers assessed the links between post-spinal hypotension and haemodynamic changes before (i.e. between baseline and before injection) spinal anaesthesia.

Results

• This analysis included a total of 20 patients with a mean age of 74 (range 66–89) yr.
• As per data, 14% decrease was noted in the stroke volume index (95% CI 9.3%–19%) before spinal anaesthesia.
• Difference was visible in the patterns of haemodynamic changes when patients were divided according to post-spinal hypotension (Y/N).
• A progressive decrease in the cardiac index was evident in the hypotensive patients, whereas in the non-hypotensive patients, it increased initially.
• Researchers observed that reduction of cardiac index from baseline before spinal anaesthesia was related to increased risk of hypotension: OR 0.79 (95% CI 0.60, 0.91).
• In addition, findings demonstrated that the predictive value of reduced cardiac index was good (AUC under ROC curve 0.91).