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

BackgroundPost-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.MethodsOne hundred ten patients, aged 60years or more were recruited to receive a single preoperative dose of dexamethasone 8mg IVI in 100ml normal saline (D group) (55 patients) 2h 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 3ml hyperbaric bupivacaine 0.5%.ResultsDemographic 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.ConclusionPost-spinal anesthesia hypotension, nausea, vomiting and shivering in elderly patients were less common after receiving a single preoperative dose of dexamethasone 8mg IVI than control.Registration numberClinicalTrials.gov Identifier: NCT 03664037, Registered 17 September 2018 - Retrospectively registered, http://www.ClinicalTrial.gov

Automated summary

The study investigated the use of dexamethasone in preventing post-spinal anesthesia hypotension in elderly patients. Results showed that patients who received dexamethasone had significantly higher blood pressure at 5th and 10th minutes post operation, and had lower need for medication and side effects compared to the control group.