Crystalloid and colloid preload for maintaining cardiac output in elderly patients undergoing total hip replacement under spinal anesthesia

Xie, Ruiqin; Wang, Lizhong; Bao, Huihui

doi:10.1016/s1674-8301(11)60024-9

Cited by 17 publications

(11 citation statements)

References 30 publications

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“…Studies also focus on the importance of intravascular filling and the role of adequate preoperative loading with either colloid or crystalloid. 36 Finally, the present study examined hypotension only during the intraoperative period, from the induction of anaesthesia until onward transfer of the patient's care in the post-anaesthesia care unit.…”

Section: Resultsmentioning

confidence: 99%

Hypotension during hip fracture surgery and postoperative morbidity: a retrospective analysis

Cusack

Beecham

Crilly

et al. 2019

Preprint

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Background: Hip fracture is a growing healthcare challenge, with 6-8% 30-day mortality and 20-30% of patients incurring major morbidity. Intraoperative hypotension during hip fracture surgery is associated with increased 30-day mortality regardless of anaesthetic technique. Although a recent trial demonstrated reduced postoperative complications by maintaining intraoperative arterial blood pressure close to baseline, there are no data correlating intraoperative hypotension during hip fracture surgery with postoperative morbidity. Objective: We evaluated the hypothesis that duration and severity of intraoperative hypotension during hip fracture surgery is associated with increased postoperative morbidity. Methods: A retrospective analysis was carried out on n=52 patients undergoing hip fracture surgery between January and June 2017. Electronic measurements of patients' intraoperative systolic arterial pressure (SAP) and mean arterial pressure (MAP) during anaesthesia were reviewed. We calculated the total duration of time where SAP or MAP were below pre-defined thresholds for hypotension (MAP < 75 mmHg, MAP < 55 mmHg, SAP ≤ 80% admission baseline, or SAP ≤ 80% pre-induction baseline). Univariate and bivariate descriptive statistics were generated for all relevant variables. With multivariable regression models containing known predictors, cumulative duration of hypotension was correlated with postoperative comorbidities as quantified by the Clavien-Dindo and Comprehensive Complication Indices. Results: Mean age (± SD) was 78 ± 13 years, 75% were female, 87% were ASA II or III and 60% underwent spinal anaesthesia.Mean Comprehensive Complication Index was 20.4 ± 19.2. Lowest absolute SAP and MAP values were 82 ± 18 mmHg and 55 ± 12 mmHg respectively. Cumulative time of SAP <80% pre-induction value adjusted to gender, age and the Charlson Comorbidity Index was associated with progression to a higher Clavien-Dindo classification (odds ratio: 1.020 per additional minute; 95% CI: 1.008 -1.035; P = 0.003). Conclusions: In this exploratory retrospective analysis, the cumulative time of hypotension during hip fracture surgery correlated with extensive postoperative morbidity when adjusting to other known predictors. Intraoperative cumulative time of hypotension may be a good candidate for larger prediction studies as a predictor of postoperative complications. A randomised controlled trial evaluating active control of intraoperative hypotension on postoperative morbidity in hip fracture

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Section: Resultsmentioning

confidence: 99%

Hypotension during hip fracture surgery and postoperative morbidity: a retrospective analysis

Cusack

Beecham

Crilly

et al. 2019

Preprint

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“…Several studies investigated benefit of preload or coload to decrease incidence of post spinal hypotension, Rufeng Xie study suggested that use of moderate volume of colloid preload is more effective than crystalloids in maintaining the CO and hemodynamic stability in elderly patients [25].…”

Section: Discussionmentioning

confidence: 99%

The Use of Passive Leg Raise Test to Predict Hypotension in Patients Undergoing Urological Procedures under Spinal Anesthesia

Abdel‐Hamid

2017

ACC

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Aim of study: A prospective observational study to examine whether Passive Leg Raise Test (PLR) administered with non invasive cardiac output monitoring by the electrical Cardiometry could be used before spinal anesthesia to determine which patients are at greatest risk for developing spinal hypotension during urological surgery. Conclusion: The use of PLR test to predict the occurrence of hypotension in patients undergoing urological procedures under spinal anesthesia was not useful.

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“…Fluid preloading has been associated with less spinal hypotension in elderly patients. 13 However there is a lack of consensus in the literature as to the type of fluid and the amount of fluid needed for preloading prior to induction of spinal anaesthesia. The literature suggests the use of fluid preloading as being protective against the development of spinal hypotension in elderly patients, and colloids more so than crystalloids.…”

Section: Interpretation Of the Studymentioning

confidence: 99%

Predictors of post-spinal hypotension in elderly patients; a prospective observational study in the Durban Metropole

Malima

Torborg

CronjÃ

et al. 2019

South Afr J Anaesth Analg

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Aims and objective: To evaluate the pre-spinal risk factors for hypotension associated with spinal anaesthesia in elderly surgical patients. Summary of background data: Hypotension is associated with morbidity and mortality following noncardiac surgery. Reducing the incidence of hypotension associated with spinal anaesthesia may be associated with improved postoperative outcomes. Methods: This was a prospective, observational study, using convenience sampling. All patients over 55 years of age scheduled to receive spinal anaesthesia for lower limb surgery were eligible. Exclusion criteria included the need for resuscitation and/or the need for vasopressors prior to anaesthesia and surgery, and patients who declined spinal anaesthesia. The dosage of spinal anaesthesia and the use of intraoperative sedation were left to the attending anaesthesiologist. The primary outcome was hypotension, which was defined as a decrease in the systolic blood pressure by 25% from the baseline, or a systolic blood pressure below 100 mmHg. The following pre-spinal risk factors were assessed in a multivariable logistic regression for their association with spinal hypotension: age, American Society of Anaesthesiologists-Physical September 2019 Status, sex, dose of local anaesthetic, isobaric bupivacaine or bupivacaine with dextrose, baseline blood pressure, baseline heart rate and fluid preloading prior to spinal anaesthesia. Results: Three hundred and eighty-nine patients were recruited. The primary outcome of spinal hypotension was independently associated with female sex (odds ratio [OR] 1.97, 95% confidence interval [CI] 1.19–3.28), increasing dosage of bupivacaine (OR 1.14, CI 1.01–1.29), and the use of isobaric bupivacaine (OR 1.50, CI 0.95–2.36). Conclusion: Spinal hypotension was associated with female sex, increasing dosage of bupivacaine, and the use of isobaric bupivacaine.

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Crystalloid and colloid preload for maintaining cardiac output in elderly patients undergoing total hip replacement under spinal anesthesia

Cited by 17 publications

References 30 publications

Hypotension during hip fracture surgery and postoperative morbidity: a retrospective analysis

Hypotension during hip fracture surgery and postoperative morbidity: a retrospective analysis

The Use of Passive Leg Raise Test to Predict Hypotension in Patients Undergoing Urological Procedures under Spinal Anesthesia

Predictors of post-spinal hypotension in elderly patients; a prospective observational study in the Durban Metropole

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