Document Detail

Anaesthesia for 1131 patients undergoing proximal femoral fracture repair: a retrospective, observational study of effects on blood pressure, fluid administration and perioperative anaemia.
MedLine Citation:
PMID:  21851345     Owner:  NLM     Status:  Publisher    
Intra-operative hypotension is a frequent occurrence during anaesthesia for hip fracture surgery in older patients with co-morbidities. We analysed retrospective data from the Brighton Hip Fracture Database to determine the intra-operative fall in systolic blood pressure, and the incidence of absolute (lowest systolic blood pressure < 90 mmHg) and relative (> 20% fall in systolic blood pressure from baseline) hypotension during general or spinal anaesthesia among 1131 non-consecutive patients with hip fracture. General anaesthesia for 489 patients (43.2%) produced a greater mean (SD) fall in systolic blood pressure than spinal anaesthesia for 578 patients (51.1%): 34.2% (13.0%) vs 29.7% (10.8%), respectively (p < 0.0001), mean difference 4.5% (95% CI 3.1-5.9%), and was associated with greater mean (SD) intra-operative fluid administration (1555 (801) ml vs 1375 (621) ml, respectively, p < 0.0001). We observed a correlation between the volume of subarachnoid hyperbaric bupivacaine 0.5% and fall in systolic blood pressure (p = 0.004): compared with patients receiving > 1.5 ml (n = 463), fewer patients receiving ≤ 1.5 ml bupivacaine 0.5% (n = 97) experienced episodes of absolute (31.1% vs 11.3%, p < 0.0001) or relative (83.9% vs 26.8%, p < 0.0001) hypotension. Both mean (SD) intravenous fluid administration (1097 ml (439) vs 1431 ml (638), p < 0.0001) and mean peri-operative fall in haemoglobin concentration (2.1 (1.8) g.dl(-1) vs 2.6 (1.7) g.dl(-1) , p = 0.009) were lower in the low-dose spinal group. If these data are confirmed by other researchers, intra-operative hypotension (and consequent haemodilution secondary to reactive fluid administration) in this patient group may be reduced by the simple expedient of administering more cautious general anaesthesia, or reduced volumes of subarachnoid local anaesthetic.
R J Wood; S M White
Related Documents :
21800965 - Negative-pressure and low-pressure hydrocephalus: the role of cerebrospinal fluid leaks...
21771275 - Delayed pressure urticaria - dapsone heading for first-line therapy?
22182355 - Adolescent acromegaly and decreased arterial distensibility despite successful treatment.
20825595 - Saline volume necessary to achieve predetermined intraluminal pressures during leak tes...
6852655 - Bone marrow pressure changes under an inflatable tourniquet.
11714015 - Combined general and epidural anaesthesia for excision of phaeochromocytoma--a unique a...
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-8-18
Journal Detail:
Title:  Anaesthesia     Volume:  -     ISSN:  1365-2044     ISO Abbreviation:  -     Publication Date:  2011 Aug 
Date Detail:
Created Date:  2011-8-19     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0370524     Medline TA:  Anaesthesia     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
© 2011 The Authors. Anaesthesia © 2011 The Association of Anaesthetists of Great Britain and Ireland.
 Specialist Trainee in Anaesthesia  Consultant in Anaesthesia, Royal Sussex County Hospital, Brighton, UK.
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

Previous Document:  Clinically relevant asymmetry of bispectral index during recovery from anaesthesia for ear-nose-thro...
Next Document:  Studies on the spread of local anaesthetic solution in transversus abdominis plane blocks*