M A Jalil Barbhuiya1, Ruhul Amin2, Jibon Kumar Paul3
1. Head, Anaesthesia & ICU, North East Medical College, Sylhet
2. Head, Orthopaedic Surgery, North East Medical College, Sylhet
3. Medical Officer, Anaesthesia, North East Medical College, Sylhet
Abstract
In elderly patients spinal Anaesthesia Subarachnoid block (SAB) induces hypotension. We have studied two different methods to prevent hypotension during SAB in elderly patients, One method is 6% Heta -starch (Haes – steril) (Colloid) and crystalloid and second method methoxamine 10mg I/M.We have selected 62 (sixty two) patients aged between 60 to 85 years with Fractured Neck of femur need surgical fixation.
Randomly selected two group One group HS, n = 32 received 6% Heta starch (Haes-steril) 500ml Followed by Hartman’s Solution 500ml. Another group MX, n = 30 received bolus injection of methoxamine (Adrenergic alpha-1 Receptor agonists)10mg I/M 10mins before induction of SAB.SAB done with 0.5% Bupivacaine 2.25-3.0 ml. Non-invasive arterial pressure was measured initially before SAB and then every 2 mins intervals from 0 to 45 mins and at 5mins. intervals thereafter. Hypotension was defined as 25% decrease from Baseline Systolic arterial pressure (SAP) or mean Arterial pressure (MAP). Methoxamine 2mg I/V was given if systolic arterial pressure (SAP) decreased to <100mm. of Hg.
Patient data, sensory level and blood loss were similar in two groups. Both the MAP & SAP initially increased from Baseline until induction of SAB and then Decreased for about 30mins. In both groups but remained higher in MX. (p < 0.05) group. In MX (p < 0.05) group heart rate decreased from Baseline but less than HS group at all times from 2 to 60min. (p < 0I) Similarly the SAP Hypotension (47% VS 75%, P = 0.03OR = 3.43 ) and MAP Hypotension (47% VS 67% P = 0.09 OR = 2.51 ) was less in MX than in group HS. Use of Methoxamine I/V for rescue (27% VS 53% P = 0.04 OR = 3.11 ) was less in group MX. Than in group HS. We Concluded that Methoxamine 10 mg. I/M given 10 mins. Before SAB in normovolaemic elderly patients reduced subsequent SAP and MAP Hypotension, HR and need for rescue vasopressor thereby compared with a combination of Colloid and crystalloid (6% Haes-steril 500ml+500ml Hartman’s solution.)