الفهرس 
Title : Effect Of Height Based Spinal Anaesthesia Dose Versus Conventional Dose On Haemodynamics In Orthopaedic Lower Limb Surgeries In Geriatrics. A Randomized Controlled Tria
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Abstract
Hypotension due to spinal anesthesia is a very well studied topic in anaesthetic research; the geriatric population are even more vulnerable group to consequences of hypotension. Even though, there is no consensus about exact dose or formula for spinal anesthesia in this population till now, preservation of perioperative hemodynamics is of great importance especially in geriatric population.
This prospective randomized controlled trial was done on 56 geriatic patients ASA class 1 or 2 (aged 60 years or more) undergoing lower limb orthopaedic surgeries under spinal anesthesia inside Kasr Al Aini hospital in orthopaedic theatre.
Ethical committee approval and informed consent were taken. The following patients were excluded from the study: patients refusing participation in the study, patients refusing spinal anesthesia, infection at the site of injection, hypovolaemia, indeterminate neurological disease, sepsis, coagulopathy, increased intracranial pressure, autonomic neuropathy, history of allergy to local anesthetics used, major cardiac, renal, hepatic diseases or severe uncontrolled hypertension.
Number of patients was divided into two equal groups each containing 28 patients.
Patients were randomized into one of the two groups.
The two groups received spinal anesthesia using hyperbaric bupivacaine 0.5% and fentanyl as the following:
1-group C (control group) received 12.5 mg of 0.5% bupivacaine (volume 2.5 ml) and 25 micrograms of fentanyl (volume of 0.5 ml) to make a total volume of 3 ml.
2-group H (height-based group) received 0.06 mg of 0.5% bupivacaine per cm height of the patient (variable volume) added to 25 micrograms of fentanyl (volume of 0.5 ml).
The bupivacaine used was Sunnypivacaine Sunny Pharmaceutical, Badr city- Cairo- Egypt whilethe fentanyl used was fentanyl Hameln Pharmaceutical Germany.
Intraoperatively, patient monitoring was established including pulse oximetry, electrocardiogram and non-invasive blood pressure monitors. Intravenous line was inserted, average of 2 baseline readings of blood pressure and pulse rate were taken. Spinal anesthesia was given to the patients at the level of L3-4 or L4-5 in a sitting position using 22 g Quincke spinal needle through midline or paramedian approach. The spinal anesthetic was injected with a speed of 0.2 cc per second. Instantly following intrathecal injection of the local anaesthetic, patients were placed into the supine position.