Background: Spinal anesthesia induced hypotension is more common and hazardous in elderly, as they have decreased physiological reserve and compromised blood supply to various vital organs. Reversal of the blunted reflexes of tachycardia following hypotension in elderly with atropine or ephedrine may help in prevention of hypotension.Methodology: Present study is a prospective, randomized, double blind, controlled trial where sixty ASAPS I-II patients undergoing urological surgeries were assigned to receive either IV normal saline (placebo) or IV atropine 0.6 mg or IV ephedrine 12 mg one minute after induction of spinal anesthesia. Heart rate (HR), mean arterial pressure (MAP), requirement mephentermine and phenylephrine and side effects profile were studied were studied. Hemodynamic parameters were compared with baseline in each and among the groups. Results:The patients were comparable with demographic data, baseline hemodynamic parameters and duration of surgery. Compared to baseline, trend of mean HR and MAP significantly dropped in placebo in most of the times (p group (5%)]. Conclusion:Administration of intravenous atropine 0.6 mg or IV ephedrine (12 mg) one min after induction of spinal anesthesia in elderly patient is safe and effective in the prevention of spinal anesthesia induced hypotension and bradycardia, requirement of vasopressors decreased without clinically significant side effects.