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8 - Hemodynamic effects of unilateral spinal anesthesia in elderly patients undergoing total hip replacement
Mehmet Eren Açık, Canan Tülay Işıl, Hacer Şebnem Türk, Ulviye Hale Dobrucalı, Pınar Sayın, Leyla Kılınç, Tansu Gökay Tarhan, Sibel Oba
Objective: Anesthetic management of elderly patients undergoing major orthopaedic operations is still a common problem. The aim of this study is to evaluate hemodynamic effects of unilateral spinal anesthesia in elderly patients undergoing total hip replacement.
Material And Methods: After local ethics committee approval and written informed consent, unilateral spinal anesthesia with hyperbaric bupivacaine 0.5% was applied to 20 patients, over the age of 65, undergoing total hip replacement. Hemodynamic measurements were recorded by arterial line with Vigileo-FloTrac system; baseline values, during the operation and after operation for 2 hours. Stroke volume, cardiac output, blood pressure and heart rate values were measured during perioperative and postoperative periods and compared by the baseline values.
Results: 60% of patients (12 people) were female, 40% (8 people) were male. Mean age was 77.6±1.75 years, mean hemoglobin value was 11.5±0.25 g/dl, mean ejection fraction was 60±1.76%. Cardiac output values decreased at 60th minute compared to baseline (p<0.05). Stroke volume at 30-50-60th minutes and 1-2nd hours postoperatively showed a decrease compared to the initial value (p<0.05). Mean arterial pressure decreased at 10th minute (p<0.05). Heart rate increased at 120th minute (p<0.05).
Concluions: Results showed a significant decrease in stroke volume and cardiac output. Unilateral spinal anesthesia leads to clinically significant hemodynamic changes in elderly patients. Cardiovascular monitoring is extremely useful in predicting hemodynamic effects of unilateral spinal anesthesia in elderly patients ungergoing total hip replacement.
Keywords: Unilateral spinal anesthesia, elderly patients, hemodynamics
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