Prevention of Spinal Anesthesia-Induced Hypotension

S
ince the late 196Os,when two reports by Wollman and Marx (1) and Marx et al. (2) advocated preemptive infusion of 1 L of crystalloid for the prevention of spinal-anesthesia-induced hypotension in women undergoing cesarean section, routine prehydration of all patients with lo-15 mL/kg of crystalloid before spinal anesthesia has gained widespread acceptance. This practice is currently being challenged, however (31,because a growing number of clinical studies have shown that, although volume prehydration may reduce the incidence of spinal-induced hypotension compared with no prehydration (4), it does not reliably prevent it (5-9). Recently, Jackson et al. (9) found no disadvantage in giving only 200 mL compared with 1 L of crystalloid prehydration in terms of the
Prevention of Spinal Anesthesia-Induced Hypotension in the Elderly: Comparison Between Preanesthetic Administration of Crystalloids, Colloids, and No Prehydration
01996 by the International Anesthesia Research Society
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An&h
Analg
1997;84:106-10
0003.2999/97/$5.00
ANESTH ANALG 1997;84:106-10
REGIONAL ANESTHESIA PREHYDRATION
Presented in part at the ASA annual scientific meeting, New Orleans, LA, October 1996. Accepted for publication September 17, 1996. Address correspondence to Donal J. Buggy, MSc, MRCPI, FFARCSI, Department of Anaesthesia, St. James’ Hospital, Dublin 8, Ireland.
blood pressure (BP) or systolic <90 mm Hg, and was treated with ephedrine 3-mg boluses. Although absolute systolic BP readings were significantly higher in the colloid group between 6 and 30 min (P < 0.05), the incidence of hypotension was not significantly different between the groups. The incidence of ephedrine use, incidence of nausea/vomiting, and median total dose of ephedrine were similar in all groups. We conclude that, in elderly patients undergoing elective procedures, withholding prehydration is not associated with any greater degree of hypotension or need for vasopressor therapy compared with crystalloid or colloid prehydration. (Anesth Analg 1997;84:106-10)
Donal Buggy, MSC, MRCPI, FFARCSI, Patrick Higgins, FFARCSI, Ciaran Moran, FFARCSI, Declan O’Brien, FFARCSI, Frances O’Donovan, FFARCSI, and Maire McCarroll, FFARCSI
Department of Anaesthesia, Cappagh Orthopaedic Hospital, Dublin, Ireland
The practice of routinely prehydrating patients by infusing a crystalloid or colloid solution (up to 1.0 L/ 70 kg) for prevention of spinal anesthesia-induced hypotension has been challenged recently, after several reports of failure to demonstrate its efficacy in young women. We compared the incidence and frequency of hypotension and vasopressor therapy after spinal anesthesia and no prehydration with crystalloid and colloid prehydration in elderly patients. Eighty-five ASA grade I or II patients (aged 60-89 yr) for elective total hip replacement were randomized to receive 500 mL crystalloid solution (Hartmanns’TM, n = 29), 500 mL colloid (HaemaccelTM , n = 28), or no prehydration (n = 28) over 10 min prior to spinal anesthesia. Hypotension was defined as a 30% decrease from baseline systolic
incidence and severity of hypotension after spinal anesthesia in young women undergoing elective cesarean section, and they recommended abandoning prehydration as a routine measure. Studies in which colloids have been given have been equally unconvincing. Reports comparing crystalloid with colloid prehydration in patients having epidural anesthesia for cesarean section found that neither prevented spinal anesthesia-induced hypotension (10,ll). Nonetheless, 5% albumin reduced the incidence of spinal-induced hypotension compared with crystalloid in this population of young women (12). Moreover, two recent reports suggested that a combination of hydroxyethyl starch 6% 1000 mL with crystalloid 1000 mL was more effective in preventing spinal anesthesia-induced hypotension than either a crystalloid-gelatin combination or hydroxyethyl starch 1000 mL alone (13,14). However, most studies of spinal-induced hypotension have been conducted on a homogeneous population of young women in obstetric units, hence their conclusions should be applied with caution to other patient populations. Moreover, laboring patients were often included in these trials, who are known to have
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