• A Alonso Chico, P Cruz Pardos, J Alvarez Grau, A Pachoco Jiménez, M Arregui Martínez de Lejarza, M L Sánchez García, and A Cardona Valdés.
• Servicio de Anestesiología y Reanimación, Hospital General Universitario Gregorio Marañón, Madrid.
• Rev Esp Anestesiol Reanim. 2003 Jan 1;50(1):17-22.

ObjectivesTo compare the intraoperative hemodynamic effects and ephedrine requirements in elderly patients undergoing orthopedic surgery under subarachnoid anesthesia with hyperbaric bupivacaine with or without fentanyl.Material And MethodsSixty patients over 75 years of age and scheduled for semi-urgent surgical repair of a fractured femur were randomized to two groups. Group F received subarachnoid surgery with 5 mg of bupivacaine and 15 micrograms of fentanyl. Group B received 7.5 mg bupivacaine. We recorded blood pressure, heart rate and oxygen saturation every 5 minutes and extension of anesthesia. Hemodynamic changes and ephedrine required by each patient were analyzed, along with side effects.ResultsGroup F patients were more hemodynamically stable 10 and 20 minutes after infusion of the anesthetic, and more hypotensive episodes occurred in group B. Group B consumed significantly more ephedrine (p < 0.05), administered to 22 patients in group B and 6 in group F. The total dose of ephedrine administered was greater in group B (190 mg) than in group F (40 mg). The extension of anesthetic block was sufficient for surgery in all cases. No side effects from fentanyl administration were observed.ConclusionAdding fentanyl to the local anesthetic used for subarachnoid anesthesia in elderly patients is effective for maintaining greater hemodynamic stability, allowing use of a lower dose of hyperbaric bupivacaine and reducing the need for intravenous ephedrine during surgery.

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