Dexamethasone blunts postspinal hypotension in geriatric patients undergoing orthopedic surgery: a double blind, placebo-controlled study

Tarek M Ashoor, Noha S Hussien, Sherif G Anis, Ibrahim M Esmat, Tarek M Ashoor, Noha S Hussien, Sherif G Anis, Ibrahim M Esmat

Abstract

Background: Post-spinal anesthesia (PSA) hypotension in elderly patients is challenging. Correction of PSA hypotension by fluids either colloids or crystalloids or by vasoconstrictors pose the risk of volume overload or compromising cardiac conditions. Dexamethasone is used to treat conditions manifested by decrease of peripheral vascular resistance. The research team was the first to test the hypothesis of its role in preventing or decreasing the incidence of PSA hypotension.

Methods: One hundred ten patients, aged 60 years or more were recruited to receive a single preoperative dose of dexamethasone 8 mg IVI in 100 ml normal saline (D group) (55 patients) 2 h preoperatively, and 55 patients were given placebo (C group) in a randomized, double-blind trial. Variations in blood pressure and heart rate in addition to the needs of ephedrine and/or atropine following spinal anesthesia (SA) were recorded. SA was achieved using subarachnoid injection of 3 ml hyperbaric bupivacaine 0.5%.

Results: Demographic data and the quality of sensory and motor block were comparable between groups. At 5th, 10th minutes post SA; systolic, diastolic and mean arterial pressures were statistically significant higher in D group. At 20th minutes post SA; the obtained blood pressure readings and heart rate changes didn't show any statistically significance between groups. The need for ephedrine and side effects were statistically significant lower in D group than C group.

Conclusion: Post-spinal anesthesia hypotension, nausea, vomiting and shivering in elderly patients were less common after receiving a single preoperative dose of dexamethasone 8 mg IVI than control.

Registration number: ClinicalTrials.gov Identifier: NCT03664037 , Registered 17 September 2018 - Retrospectively registered, http://www.ClinicalTrial.gov.

Keywords: Anesthesia, subarachnoid; Dexamethasone; Geriatric; Hemodynamics.

Conflict of interest statement

The authors declared that they had no competing interests.

Figures

Fig. 1
Fig. 1
Flow chart of the study
Fig. 2
Fig. 2
Changes in HR among groups
Fig. 3
Fig. 3
a Minimum HR, b Minimum SBP, c Minimum DBP, d Minimum MBP changes between groups
Fig. 4
Fig. 4
Possible mechanisms of Dexamethasone in alleviating spinal anesthesia induced hypotension

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