Prevention of Spinal Anesthesia Induced Hypotension in Elderly: Comparison of Prophylactic Atropine with Ephedrine

Abstract

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.

Effects of prophylactic atropine in prevention of spinal anesthesia induced hypotension and bradycardia in geriatrics undergoing urological surgeries at a resource limited setting in Central Ethiopia, 2018; prospective cohort study.

“…Another RCT that compares atropine and ephedrine with a placebo showed MAP was comparable between atropine and ephedrine groups but in placebo group MAP was signi cantly low compared to other groups [19]. This is also in line with our ndings showing a better maintenance of MAP after spinal anesthesia in the atropine exposed group than un-exposed group especially in the rst 30 minutes.…”

“…In the current study the occurrence of tachycardia had no signi cant difference between exposed and unexposed groups. This was also in line with other studies that showed the re ex tachycardia after atropine prophylaxis in patients undergoing urological procedures under spinal anesthesia is not statistically signi cant [2,6,19].…”

“…Another RCT that compares the prophylactic effect of atropine and ephedrine with a placebo group also showed that as compared to the placebo, mean heart rate was signi cantly increased in atropine and ephedrine groups at all the times. This study also showed that maximum heart rate in atropine group was 89.30 ± 14.62 bpm at 5 th minute [19].…”