ROLE OF PRELOADING WITH AND WITHOUT INTRAMUSCULAR EPHEDRINE TO PREVENT POST SPINAL HYPOTENSION IN ELDERLY PATIENTS

Post Spinal Hypotension in Elderly Patients

Abstract

Objective: To evaluate the efficacy of intramuscular ephedrine along with preloading in prevention of post spinal hypotension in elderly patients.

Study Design: Randomized controlled trial.

Place and Duration of Study: Department of Anaesthesia and Intensive Care Combined Military Hospital Peshawar, from 20^th March 2007 to 20^th March 2008.

Material and Methods: A total of 100 patients of ASA I and II were selected. The patients were randomly divided by random numbers table into two groups of 50 each. Group A was preloaded with ringer solution 15 ml/kg and intramuscular injection of 1 ml normal saline as placebo was given. Group B preloaded with 7.5ml/kg and intramuscular injection of ephedrine 0.5 mg/kg was given. Heart rate and mean arterial pressure were monitored after the spinal blockade. Hypotension was treated with intravenous bolus of 5mg ephedrine and additional rapid infusion of lactated ringers.

Results: In group A, hypotension occurred in 30 (60%) patients as compared to group B, where hypotension occurred in 11 (22%) patients. In group A, ephedrine 5mg (bolus) was given in 16 (32%) patients and ephedrine 10mg (2 boluses) were given in 14 (28%) patients, while in group B, ephedrine 5mg (1 bolus) was given in 11 (22%) patients.

Conclusion: It is concluded from the results of this study that less preloading is required in intramuscular ephedrine group and hence preloading along with intramuscular ephedrine is more effective in preventing hypotension in elderly patients after spinal anaesthesia as compared to preloading alone.