Norepinephrine Versus Phenylephrine for Preventing Spinal Anesthesia Induced Hypotension in Elderly

• Status: Completed
• Trial end date: 2020-03-26
• Target enrollment: 0
• Participant gender: All

Summary

Various regimens were used for prevention of hypotension; most of these regimens included the use of vasopressors. Ephedrine is commonly used vasopressor for management and prophylaxis of hypotension; however, ephedrine is usually associated with tachycardia which increases oxygen consumption; thus, it might be potentially harmful in this special group of patients. Phenylephrine (PE) is another vasopressor which is characterized by α agonistic activity. PE had been the preferred vasopressor for prophylaxis against post-spinal hypotension especially in obstetric population.

it was reported that PE improved the intraoperative hemodynamic profile in elderly patients undergoing lower extremities orthopedic surgery under spinal anesthesia. PE (a pure α agonist) was reported to decrease cardiac output which limit its use in patients with compromised cardiac contractility; this fact makes the use of PE in elderly patients questionable. Norepinephrine (NE) is characterized by α agonistic and weak β agonistic activity; thus, NE is characterized by less cardiac depression compared to PE. NE was recently introduced for prophylaxis against post-spinal hypotension in obstetric anesthesia. In non-obstetric population, although, NE infusion effectively maintained patients hemodynamics during general anesthesia, its use during spinal anesthesia was not adequately evaluated in elderly population

• Phase: Phase 4
• Accepts Healthy Volunteers?: No

Details

• Lead Sponsor: Kasr El Aini Hospital
• Treatments: Anesthetics; Norepinephrine; Oxymetazoline; Phenylephrine

Criteria

Inclusion Criteria:

• Elderly patients (>65), ASA I-II-III, scheduled for hip joint surgery under spinal anesthesia

Exclusion Criteria:

• Contraindication of spinal anesthesia (patient's refusal, infection at injection site, allergy, increased intracranial tension, coagulopathy, tight valvular lesion),

• history of allergy to any of the study's drugs,

• Patients with cardiac morbidities (impaired contractility with ejection fraction < 50%, heart block, arrhythmias),

• hypertensive patients,

• patients on beta blockers,

• patient with hyperthyroidism

• patients on monoamine oxidase inhibitors (MAOI) will be excluded from the study.