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A Journal on Anesthesiology, Resuscitation, Analgesia and Intensive Care
Minerva Anestesiologica 2008 December;74(12):691-6
Hypotension during surgery for femoral neck fracture in elderly patients: effect of anaesthetic techniques. A retrospective study
Minville V. 1, Asehnoune K. 2, Delussy A. 1, Fourcade O. 1, Colombani A. 1, Rabinowitz A. 3, Samii K. 1
1 Department of Anaesthesiology and Intensive Care, University Hospital of Toulouse University of Paul Sabatier, Toulouse, France; 2 Department of Anaesthesiology and Intensive Care, University Hospital of Nantes Hôtel-Dieu, Nantes, France; 3University of Pennsylvania, School of Medicine, Philadelphia, PA, USA
Background. The aim of this retrospective study was to compare the incidence of hypotension between different anaesthetic techniques, including general anaesthesia (GA), spinal anaesthesia single injection (SA), continuous spinal anaesthesia with 2.5 mg bolus injections as needed (CSA 2.5) or 5 mg bolus injections as needed (CSA 5) in elderly patients (>75 yrs old) undergoing surgery for femoral neck fractures.
Methods. Demographic, surgical and hemodynamic data from 333 patients over a four year period within a single hospital were recorded and examined.
Results. Forty-two patients underwent GA, 109 underwent SA, 61 underwent CSA 5, and 121 underwent CSA 2.5. Patients receiving GA, SA or CSA 5 had a higher incidence of hypotension (83%, 68%, and 34%, respectively) than patients who underwent CSA 2.5 (4%; P<0.05). The CSA 2.5 group required less colloid infusion (490±50 mL) than the GA and SA groups (810±330 and 645±230 mL, respectively). The CSA 2.5 group also required less crystalloid infusion volume (760±371 mL) than the GA group (1140±770 mL). Ephedrine infusion was higher in the GA and SA groups (30±10 and 26±9 mg, respectively) than the CSA 2.5 (15±8 mg; P<0.05).
Conclusion. This study demonstrated that CSA 2.5 causes fewer episodes of hypotension than other anaesthetic techniques for surgical repair of hip fracture in elderly patients.