| Title: |
Hypobaric Unilateral Spinal Anesthesia Versus General Anesthesia for Hip Fracture Surgery in the Elderly: A Randomized Controlled Trial |
| Authors: |
Simonin, Marine; Delsuc, Claire; Meuret, Pascal; Caruso, Liana; Deleat-Besson, Robert; Lamblin, Antoine; Huriaux, Laetitia; Abraham, Paul; Bidon, Cyril; Giai, Joris; Riche, Benjamin; Rimmelé, Thomas |
| Contributors: |
Laboratoire de Biométrie et Biologie Evolutive - UMR 5558 (LBBE); Université Claude Bernard Lyon 1 (UCBL); Université de Lyon-Université de Lyon-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS); Hospices Civils de Lyon (HCL); Service de Biostatistiques Lyon |
| Source: |
ISSN: 0003-2999. |
| Publisher Information: |
CCSD; Lippincott, Williams & Wilkins |
| Publication Year: |
2022 |
| Collection: |
HAL Lyon 1 (University Claude Bernard Lyon 1) |
| Subject Terms: |
[STAT]Statistics [stat] |
| Description: |
International audience ; BACKGROUND: Hypotension during surgery is frequent in the elderly population and is associated with acute kidney and myocardial injury, which are, themselves, associated with increased 30-day mortality. The present study compared the hemodynamic effects of hypobaric unilateral spinal anesthesia (HUSA) to general anesthesia (GA) in patients ≥70 years of age undergoing hip fracture surgery. METHODS: We conducted a single-center, prospective, randomized study. In the HUSA group, patients were positioned with the operated hip above, and the hypobaric anesthetic solution was composed of 9 mg ropivacaine, 5 µg sufentanil, and 1 mL of sterile water. Anesthesia was adjusted for the GA group. Mean arterial pressure (MAP) was measured with a noninvasive blood pressure upper arm cuff every 3 minutes. Hypotension was treated with a bolus of ephedrine and then a continuous intravenous of norepinephrine to obtain a MAP ≥65 mm Hg. Primary outcome was the occurrence of severe hypotension, defined as a MAP 12 consecutive minutes. RESULTS: A total of 154 patients were included. Severe hypotension was more frequent in the GA group compared to the HUSA group (odds ratio, 5.6; 95% confidence interval, 2.7–11.7; P < .001). There was no significant difference regarding the short-term outcomes between the HUSA and GA groups: acute kidney injury (respectively, 5.1% vs 11.3%; P = .22), myocardial injury (18.0% vs 14.0%; P = .63), and 30-day mortality (2.4% vs 4.7%; P = .65). CONCLUSIONS: HUSA leads to fewer episodes of severe intraoperative hypotension compared to GA in an elderly population undergoing hip fracture surgery. |
| Document Type: |
article in journal/newspaper |
| Language: |
English |
| DOI: |
10.1213/ANE.0000000000006208 |
| Availability: |
https://hal.science/hal-04385143; https://doi.org/10.1213/ANE.0000000000006208 |
| Accession Number: |
edsbas.73CF111A |
| Database: |
BASE |