Hemodynamic Effects of Continuous Spinal Anesthesia in Patient Aged Over 65 Years
Hemodynamic Effects of Continuous Spinal Anesthesia in Patient Aged Over 65 Years
Compared to single-dose spinal anesthesia, continuous spinal anesthesia using small titrated
 doses of local anesthetic, was safe, efficient and provided better hemodynamic profile in
 elderly patients.

 The aim of this study was to investigate the hemodynamic effects of continuous spinal
 anesthesia in elderly patients undergoing knee arthroplasty.

 Investigators use the FloTrac sensor/Vigileo haemodynamic monitoring system to assess
 modification blood pressure, stroke volume and cardiac output during anesthesia and specialy
 after every bolus of spinal anesthesia, after inflating the tourniquet and after putting it
 off.

 they recorded number of hypotension episodes, ephedrine bolus and consumption until 2 hours
 after the end of surgery.
The aim of this study was to investigate the hemodynamic effects of continuous spinal
 anesthesia (CSA) in elderly patients undergoing knee arthroplasty.

 Inclusion criteria:

 Adult patients, aged more than 65 years scheduled for elective total knee arthroplasty under
 regional anesthesia.

 Study Design :

 Patients had a transthoracic echocardiography one to three months before the surgical
 procedure, performed by a cardiologist.

 An oral intake of 250 ml of water was taken 2 hours before surgery. In the operating room,
 patients received monitoring with electrocardiogram, pulse oximetry and had their blood
 pressure measured and recorded via an indwelling radial arterial catheter putting under local
 anesthesia.

 This catheter was connected to the FloTrac sensor/Vigileo haemodynamic monitoring systeme to
 track continuously stroke volume and cardiac output.

 All patients were given nasal oxygen during all the procedure to keep oxygen saturation > 95
 %. Fluid therapy was limited to 4 ml/kg/h until tourniquet release.

 Subarachnoid puncture was performed with a 19-Gauge Tuohy needle at the L3-S1 interspace
 using a midline approach. Three cm of a 22-Gauge catheter was introduced through the needle.
 An initial dose of 2,5 mg isobaric 0,5% bupivacaine was injected through the catheter.
 Additional 2,5 mg isobaric 0,5% bupivacaine doses were injected every 10 minutes until
 sensory blockade reached T10.

 Ephedrine 6 to 9 mg was given if systolic arterial pressure < 90 mmHg or < 100 mmHg with
 clinical signs of poor tolerance (dizziness, anxiety, dyspnea, vomiting).

 Sample size We included 20 patients in this observational study.
Inclusion Criteria:

 -  Adult patients, aged more than 65 years

 -  scheduled for elective total knee arthroplasty

 -  under regional anesthesia

 Exclusion Criteria:

 -  contraindication to regional anesthesia

 -  or the patients who refused to give consent,

 -  patients with anemia (hemoglobin < 13 g/dl for male and hemoglobin < 12 g/dl for
 female),

 -  cardiac arrhythmias,

 -  NYHA score > 2,

 -  ASA > 2

 -  Cardiac ejection fraction < 50 %,

 -  valvulopathy,

 -  pulmonary artery hypertension

 -  and relaxation abnormality