Department of Anesthesia and Intensive Care, Ain Shams University, Cairo, Egypt.
Department of Anesthesia and Intensive Care, Faculty of Medicin, Ain Shamse University, Cairo, Egypt.
BMC Anesthesiol. 2021 Jan 11;21(1):11. doi: 10.1186/s12871-021-01232-w.
Post-spinal anesthesia (PSA) hypotension in elderly patients is challenging. Correction of PSA hypotension by fluids either colloids or crystalloids or by vasoconstrictors pose the risk of volume overload or compromising cardiac conditions. Dexamethasone is used to treat conditions manifested by decrease of peripheral vascular resistance. The research team was the first to test the hypothesis of its role in preventing or decreasing the incidence of PSA hypotension.
One hundred ten patients, aged 60 years or more were recruited to receive a single preoperative dose of dexamethasone 8 mg IVI in 100 ml normal saline (D group) (55 patients) 2 h preoperatively, and 55 patients were given placebo (C group) in a randomized, double-blind trial. Variations in blood pressure and heart rate in addition to the needs of ephedrine and/or atropine following spinal anesthesia (SA) were recorded. SA was achieved using subarachnoid injection of 3 ml hyperbaric bupivacaine 0.5%.
Demographic data and the quality of sensory and motor block were comparable between groups. At 5th, 10th minutes post SA; systolic, diastolic and mean arterial pressures were statistically significant higher in D group. At 20th minutes post SA; the obtained blood pressure readings and heart rate changes didn't show any statistically significance between groups. The need for ephedrine and side effects were statistically significant lower in D group than C group.
Post-spinal anesthesia hypotension, nausea, vomiting and shivering in elderly patients were less common after receiving a single preoperative dose of dexamethasone 8 mg IVI than control.
ClinicalTrials.gov Identifier: NCT03664037 , Registered 17 September 2018 - Retrospectively registered, http://www.ClinicalTrial.gov.
老年患者椎管麻醉后（PSA）低血压是一个挑战。通过液体（胶体或晶体）或血管收缩剂纠正 PSA 低血压会带来容量超负荷或损害心脏状况的风险。地塞米松用于治疗外周血管阻力降低引起的病症。研究小组首次测试了其在预防或降低 PSA 低血压发生率方面的作用假设。
110 名年龄在 60 岁或以上的患者被招募接受单次术前地塞米松 8mg IVI 在 100ml 生理盐水（D 组）（55 例）2h 术前，55 例患者接受安慰剂（C 组）在随机、双盲试验中。记录椎管麻醉（SA）后血压和心率的变化，以及需要使用麻黄碱和/或阿托品。SA 通过蛛网膜下腔注射 3ml 高比重布比卡因 0.5%实现。
两组的人口统计学数据和感觉和运动阻滞的质量相当。在 SA 后第 5、10 分钟，D 组的收缩压、舒张压和平均动脉压有统计学意义上的升高。在 SA 后第 20 分钟，两组的血压读数和心率变化无统计学意义。D 组需要麻黄碱和副作用的发生率明显低于 C 组。
与对照组相比，老年患者在接受单次术前地塞米松 8mg IVI 后，PSA 后低血压、恶心、呕吐和寒战较少见。
ClinicalTrials.gov 标识符：NCT03664037，于 2018 年 9 月 17 日注册-回顾性注册，http://www.ClinicalTrial.gov。
