Norepinephrine Versus Phenylephrine for Preventing Spinal Anesthesia Induced Hypotension in Elderly
Status:
Completed
Trial end date:
2020-03-26
Target enrollment:
Participant gender:
Summary
Various regimens were used for prevention of hypotension; most of these regimens included the
use of vasopressors. Ephedrine is commonly used vasopressor for management and prophylaxis of
hypotension; however, ephedrine is usually associated with tachycardia which increases oxygen
consumption; thus, it might be potentially harmful in this special group of patients.
Phenylephrine (PE) is another vasopressor which is characterized by α agonistic activity. PE
had been the preferred vasopressor for prophylaxis against post-spinal hypotension especially
in obstetric population.
it was reported that PE improved the intraoperative hemodynamic profile in elderly patients
undergoing lower extremities orthopedic surgery under spinal anesthesia. PE (a pure α
agonist) was reported to decrease cardiac output which limit its use in patients with
compromised cardiac contractility; this fact makes the use of PE in elderly patients
questionable. Norepinephrine (NE) is characterized by α agonistic and weak β agonistic
activity; thus, NE is characterized by less cardiac depression compared to PE. NE was
recently introduced for prophylaxis against post-spinal hypotension in obstetric anesthesia.
In non-obstetric population, although, NE infusion effectively maintained patients
hemodynamics during general anesthesia, its use during spinal anesthesia was not adequately
evaluated in elderly population