Hemodynamic effects of combined spinal-epidural anesthesia in elderly patients

Objective To approach the hemodynamic effects of combined spinal-epidural anesthesia in 65 years or older patients. Methods In a prospective study, 60 American Society of Anesthesiologists Ⅱ～Ⅲ patients (aged 65 yr or older), undergoing elective TKR surgery were randomLy assigned to either CSE an-esthesia (CSEA, n=30) or epidurai anesthesia alone (CEA, n=30). The age, sex, duration of surgery, blood loss, fluid infusion during the surgery and main complications were recorded. Hemodynamic measure-ments included invasive or non-invasive mean arterial blood pressure (MAP), heart rate (HR) before an-aesthesiaufe, 15 wins after anaesthesia and the end of surgery. Our primary endpoint (outcome) was the number of hypotension and bradycardic episodes (defined as MAP<70 mmHg and HR<50 beats per mi-nute). Cases of blood bandage were also recorded. Results There was no significant difference between two groups in the age, sex, duration of surgery, blood loss, fluid infusion and main complications. Using univariate analysis, we found no significant differences between the groups in regards to MAP, HR during the perioperative period. The incidence of hypotension was similar in both groups (7 patients in CSEA and 6 in CEA group, P=0.704), as of bradycardia (3 patients in CSE, 5 in epidural, P=0.754). The inci-dance of blood bandage pain of CSE group was higher than CSEA group. Conclusion Combined spinal-epi-dural anesthesia and epidural anesthesia alone during TKB surgery are associated with the same incidence of hypotension with statistically and clinically similar hemodynamic responses. Key words: bemodynamics;  combined spinal-epidurai anesthesia;  elderly patients