• Miodrag Žunić, Krčevski Škvarč Nevenka N Department of Anesthesiology, Intensive Care and Pain Management, University Medical Center Maribor, Ljubljanska ulica 5, 2000, Maribor, Sloveni, and Mirt Kamenik.
• Department of Anesthesiology, Intensive Care and Pain Management, University Medical Center Maribor, Ljubljanska ulica 5, 2000, Maribor, Slovenia. miodrag.zunic@doctor.com.
• BMC Anesthesiol. 2019 Nov 11; 19 (1): 207.

BackgroundWe studied the influence of ephedrine or phenylephrine infusion administered immediately after spinal anesthesia (SA) on hemodynamics in elderly orthopedic patients.MethodsA prospective, randomized, double-blind, placebo-controlled study. After a subarachnoid injection of 15 mg of levobupivacaine, the participants received an infusion of either ephedrine 20 mg (E group), phenylephrine 250 mcg (P group) or saline (C group) within 30 min. We measured blood pressure, cardiac index (CI) and heart rate (HR) from 15 min before to 30 min after SA.ResultsSeventy patients were included in the final analysis. At the end of measurements, mean arterial pressure (MAP) decreased significantly after SA in comparison to the baseline value in the C group but was maintained in the P and E group, with no significant differences between the groups. CI decreased after SA in the C group, was maintained in the P group, and increased significantly in the E group with significant differences between the C and E group (p = 0.049) also between the P and E (p = 0.01) group at the end of measurements. HR decreased significantly after SA in the C and P group but was maintained in the E group, with significant differences between the P and E group (p = 0.033) at the end of measurements.ConclusionsHemodynamic changes after SA in elderly orthopedic patients can be prevented by an immediate infusion of phenylephrine or ephedrine. In addition to maintaining blood pressure, the ephedrine infusion also maintains HR and increases CI after SA.Trial RegistrationISRCTN registry with registration number ISRCTN44377602, retrospectively registered on 15 June 2017.

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