Prospective cohort study on prophylactic use of intravenous atropine in prevention of spinal anesthesia induced hypotension and bradycardia in fifty years and above patients undergoing urological surgery at Tikur Anbesa specialized hospital
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Date
2018-06
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Addis Ababa Universty
Abstract
Spinal anesthesia induced hypotension is common and hazardous in elderly patients. Many techniques are being used to prevent and treat spinal anesthesia induced hypotension and bradycardia; including preloading, coloading, and vasopressors. Elderly cannot tolerate aggressive fluid challenges and the reflex tachycardia secondary to vasopressor use. Besides their adverse effects vasopressors are not easily available in most Ethiopian hospitals. The current study investigated whether prophylactic use of atropine helps in prevention of spinal anesthesia induced hypotension and bradycardia in elderly.
Objective: To assess the effect of prophylactic atropine in preventing spinal anesthesia induced hypotension and bradycardia in elderly patients undergoing urological surgery at Tikur Anbesa Specialized hospital from December 1, 2017 to February 30, 2018 G.C.
Methodology: Hospital based prospective cohort study was employed on 76 elderly patients with American Society of Anesthesiologists class I & II underwent urologic surgery under spinal anesthesia at Tikur Anbesa Specialized hospital during the study period. Samples were selected using systematic random sampling technique. Hemodynamic parameters and total vasopressor consumption were compared between the exposed and un-exposed groups. Descriptive data were displayed using tables and figures. Continuous data were analyzed using independent samples t test and Mann Whitey U test. Chi-square test and fisher exact test was used to analyze categorical data. P Value < 0.05 was considered statistically significant.
Results: A total of 76 patients were included in this study. Patients were comparable in age, sex weight and other demographics. There was no significant difference in baseline heart rate, mean arterial pressure, type & duration of surgery and total fluid administrations. There was a statistically significant difference in mean heart rate and mean arterial pressure between the atropine exposed and un-exposed groups. As compared to exposed group (7.9%), total vasopressor consumption was high in un- exposed group (28.9%) with P = 0.038.
Conclusion: The use of prophylactic atropine IV with in one minute of induction of spinal anesthesia maintains mean arterial pressure and heart rate in elderly patients thereby reducing incidence of hypotension and bradycardia.
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Keywords
Spinal anesthesia,hypotension