Background: We studied the influence of ephedrine or phenylephrine infusion administered immediately after\nspinal anesthesia (SA) on hemodynamics in elderly orthopedic patients.\nMethods: A prospective, randomized, double-blind, placebo-controlled study.\nAfter a subarachnoid injection of 15 mg of levobupivacaine, the participants received an infusion of either\nephedrine 20 mg (E group), phenylephrine 250 mcg (P group) or saline (C group) within 30 min. We measured\nblood pressure, cardiac index (CI) and heart rate (HR) from 15 min before to 30 min after SA.\nResults: Seventy patients were included in the final analysis. At the end of measurements, mean arterial pressure\n(MAP) decreased significantly after SA in comparison to the baseline value in the C group but was maintained in\nthe P and E group, with no significant differences between the groups. CI decreased after SA in the C group, was\nmaintained in the P group, and increased significantly in the E group with significant differences between the C\nand E group (p = 0.049) also between the P and E (p = 0.01) group at the end of measurements. HR decreased\nsignificantly after SA in the C and P group but was maintained in the E group, with significant differences between\nthe P and E group (p = 0.033) at the end of measurements.\nConclusions: Hemodynamic changes after SA in elderly orthopedic patients can be prevented by an immediate\ninfusion of phenylephrine or ephedrine. In addition to maintaining blood pressure, the ephedrine infusion also\nmaintains HR and increases CI after SA.
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