Hemodynamic effects of norepinephrine versus phenylephrine infusion for prophylaxis against spinal anesthesia-induced hypotension in the elderly population undergoing hip fracture surgery: a randomized controlled trial

Abstract

Background: Elderly population are at increased risk of spinal anesthesia-induced hypotension increasing their risk for postoperative morbidity and mortality. This study aimed to compare the hemodynamic effects of prophylactic infusion of norepinephrine (NE) versus phenylephrine (PE) in elderly patients undergoing hip fracture surgery under spinal anesthesia. Methods: Elderly patients scheduled for hip fracture surgery were randomized to receive either NE infusion (8 µg/min) (NE group, n = 31) or PE infusion (100 µg/min) (PE group, n = 31) after spinal anesthesia. Outcomes included mean heart rate, mean blood pressure, cardiac output, incidence of spinal anesthesia-induced hypotension, incidence of bradycardia, and incidence of hypertension. Results: Sixty-two patients with a mean age of 71 ± 6 years were included in the final analysis (31 patients in each group). The NE group showed a higher mean heart rate and cardiac output than the PE group. The NE group had a lower incidence of reactive bradycardia (10% vs. 36%, P = 0.03) and hypertension (3% vs. 36%, P = 0.003) than the PE group. No study participant developed hypotension, and the mean blood pressure was comparable between the two groups. Conclusions: Both NE and PE infusions effectively prevented spinal anesthesia-induced hypotension in elderly patients undergoing hip fracture surgery. However, NE provided more hemodynamic stability than PE; maintaining the heart rate, higher cardiac output, less reactive bradycardia, and hypertension.

Oral midodrine for prophylaxis against post-spinal anesthesia hypotension during hip arthroplasty in elderly population: a randomized controlled trial

“…It was found that pre-hydration alone would not eliminate spinal hypotension [ 23 , 24 ]. Therefore, there is increased interest in the use of vasopressors, preferably prophylactic, to decrease the incidence and severity of hypotension [ 25 ].…”

Association between General Anesthesia and the Occurrence of Cerebrovascular Accidents in Hip Fracture Patients

“…Prior studies have shown that if the occurrence of cerebrovascular accidents was regarded as the only dependent variate and factors such as general anesthesia and number of anesthetic drugs were regarded as the independent variate, then BMI ≥23 kg/m 2 , number of anesthetic drugs ≥4, and intraoperative blood pressure ≥140 mmHg were also the risk factors affecting cerebrovascular accidents in hip fracture patients [ 24 ]. The association of BMI with cerebrovascular accidents lies in the fact that the diet of obese patients has an excessive amount of oil-containing components and that their obesity is aggravated by postoperative bed rest, but when general anesthesia is considered as a variate, body mass can also affect the amount of anesthetic drugs.…”

Norepinephrine prevents hypotension in older patients under spinal anesthesia with intravenous propofol sedation: a randomized controlled trial

“…Recently, however, norepinephrine has been described as an effective alternative to phenylephrine for the prevention and treatment of hypotension during SA for cesarean delivery 6 – 11 . Relatively few studies have evaluated the effectiveness of continuous infusion of norepinephrine in preventing IOH in older patients 12 , 13 . Therefore, in this study, we aimed to investigate whether norepinephrine administration can effectively prevent hypotension in older patients aged ≥ 70 years undergoing unilateral primary hip surgery under SA with propofol sedation.…”