Prevalence and Risk Factors of Hypotension in Elderly Undergoing Spinal Anesthesia in Maharat Nakhonratchasima Hospital; A Retrospective Study
Keywords:
Spinal anesthesia, elderly, hypotensionAbstract
Hypotension after spinal anesthesia is associated with perioperative morbidity and mortality especially in senior patients. This study aimed to evaluate the prevalence and risk factors of hypotension after spinal anesthesia in elders undergoing surgery.
This retrospective study was conducted at Maharat Nakhonratchasima Hospital., All cases aged above 65 scheduled to surgery under spinal anesthesia were reviewed. Period of study was between October 2019 and June 2020. Collected data consisted of patients’ demographics, laboratory, vital signs, preload fluid amount, position while performing anesthesia, bupivacaine type including dosage. Adjusted odds ratios (aOR) and p-value were presented for multiple logistic regression.
Four hundred and nineteen elderly participants were recruited. Hypotension after spinal anesthesia occurred in 40.8 percent (171/419) of the patients which independently associated with underlying ischemic heart disease (OR 3.94, 95% CI 1.71-10.07, p=0.002), preoperative systolic blood pressure below 140 mmHg (OR 1.61, 95% CI 1.71-2.86, p=0.029) and baseline hemoglobin level less than 12 g/dL [(Hb<10: OR 5.32, 95% CI 2.45-14.1, p<0.001), (Hb 10-11.9: OR 1.75, 95% CI 1.17-3.08, p=0.019)]. These factors were statistically significant (p-value<0.05; all)
To improve patient care, there should be extra surveillance in elderly patients at risk for hypotension after spinal anesthesia. Elders with history of myocardial infarction, baseline systolic blood pressure below 140 mmHg and baseline hemoglobin less than 12 g/dL should be concerned. Moreover, elderly patients who have baseline hemoglobin less than 12 g/dL should receive blood transfusion before induction of spinal anesthesia aiming to reduce further complications from hypotension.
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