Midodrine for Prophylaxis Against Post Spinal Hypotension in Elderly Population
Status:
Not yet recruiting
Trial end date:
2023-01-01
Target enrollment:
Participant gender:
Summary
Hip fracture is a common and serious healthcare problem which commonly affects elderly
populations. The common route of anesthesia for hip arthroplasty is spinal anesthesia.
Elderly populations are characterized by high incidence of post spinal anesthesia
hypotension; furthermore, elderly patients commonly have systemic medical disorder;
therefore, this population is highly vulnerable to perioperative hypotension. Moreover ,
intraoperative hypotension during hip surgery has been recently recognized as a major risk
factor for postoperative morbidity and mortality.
Through the effect of spinal anesthesia on sympathetic system Veno-dilatation, decreased
venous return, and consequently decreased cardiac output and hypotension will be induced.
Vasopressors are commonly used for prophylaxis against post spinal hypotension in different
patient subgroups. The commonly used drugs are alpha-adrenoreceptor agonists such as
ephedrine, phenylephrine, and recently norepinephrine. All these agents are effective in
maintenance of blood pressure; however, they have some disadvantages; ephedrine is commonly
associated with tachycardia, phenylephrine and norepinephrine are associated with
bradycardia. All the former mentioned drugs are used intravenously.
Midodrine hydrochloride is another alpha-adrenoreceptor agonist drug which is used for
management of various hypotensive disorders. Midodrine is the prodrug which is metabolized to
desglymidodrine which is a direct arteriolar and venous vasopressor. Midodrine is
characterized by being an oral drug, with minimal central nervous system side effects, and
good oral bioavailability. No studies had evaluated the efficacy of midodrine for prophylaxis
against post-spinal anesthesia hypotension in elderly population.
Aim of the work:
This thesis aims to evaluate the efficacy and safety of oral 5 mg of midodrine compared to
placebo in prophylaxis against post-spinal hypotension in elderly patients undergoing hip
arthroplasty