الفهرس 
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Abstract
This study was carried out on sixty patients ASA I ,II or III physical status scheduled for lower limb orthopedic surgery under spinal anesthesia at Emergency Hospital, Mansoura University. Their age ranging between 60 and 87 years old. Study Exclusion criteria were; patients catagorized as ASA IV or V physical status, body wieght more than 100 kg, hypertensive patients or any contraindications to spinal anesthesia. These patients were randomly allocated into four groups according to the type of the fluid preload which was given 20 minutes prior to spinal anesthesia. Colloid group. : Patient received 500 mL 6% hydroxyethylstarch. Crystalloid group. : Patient received 1000 mL lactated Ringer’s. Combined group. : Patient received 500 mL lactated Ringer’s plus 250 mL 6% hydroxyethylstarch. No Preload group. : Patient received continuous infusion of lactated Ringer’s solution at a rate of 1 mL/minute. The mean dose of ephedrine and the incidence of hypotension was significantly lower in the colloid group 3 of 15 (20%), compared with crystalloid group 9 of 15 (60%), combined group 7 of 15 (46%), and no preload group 11 of 15 (73%). Intravascular administration of colloid, crystalloid or combination of both resulted in a significant increase of the CVP, then then decreased after spinal block. From the result of this study, we can conclude that the use of colloid solution as a pre-emptive infusion is demonstrably effective to attenuate spinal anesthesia-induced hypotension in elderly patients undergoing lower limb orthopedic surgery as compared with crystalloid or no fluid preload. However, the incidence of hypotension was only reduced but not completely eliminated.