This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Minville, V. Articles by Fourcade, O. Search for Related Content PubMed Articles by Minville, V. Articles by Fourcade, O. Related Collections Neuroanesthesia Physiology Regional Anesthesia

---

NEUROSURGICAL ANESTHESIOLOGY AND NEUROSCIENCE

The Effects of Spinal Anesthesia on Cerebral Blood Flow in the Very Elderly

Vincent Minville, MD^*, Karim Asehnoune, MD, PhD, Sabrina Salau, MD^*, Benoît Bourdet, MD^*, Bernard Tissot, MD^*, Vincent Lubrano, MD, and Olivier Fourcade, MD, PhD^*

From the *Department of Anesthesiology and Intensive Care, GRCB 48, University Hospital of Toulouse, University Paul Sabatier, Toulouse, France; Department of Anesthesiology and Intensive Care, University Hospital of Nantes, Nantes, France; and Institut National de la Santé et de la Recherche Médicale (Unité 455), Federation of Neurosurgery, University Hospital of Toulouse, Toulouse, France.

Address correspondence and reprint requests to Dr. Vincent Minville, Department of Anesthesiology and Intensive Care, University Hospital of Toulouse, Rangueil Hospital-Orthopedic section, 1, Ave. Jean Poulhès, Toulouse, France. Address e-mail to vincentminville{at}yahoo.fr.

Abstract

BACKGROUND: Aging and disease may make elderly patients particularly susceptible to hypotension during spinal anesthesia. However, the impact of small-dose bupivacaine on cerebral hemodynamics is not known. In this study, we assessed the effects of spinal anesthesia on cerebral blood flow (CBF) in very elderly patients.

METHODS: We prospectively studied 20 patients aged >75 yr who underwent open surgical repair of a hip fracture and compared them with a control group of patients younger than 60 yr. Patients were placed in the lateral decubitus position to receive spinal anesthesia at L4–5 level. Noninvasive automated arterial blood pressure, heart rate, and transcranial Doppler measurements were recorded before spinal anesthesia (baseline = T0), 5 min after the end of local anesthetic injection (T1), 10 min after spinal anesthesia (T2), and in the postanesthesia care unit (T3).

RESULTS: Systolic blood pressure significantly decreased at T1 (115 ± 25 mm Hg) and T2 (114 ± 24 mm Hg) compared with T0 (136 ± 21 mm Hg) in the elderly group. Systolic and diastolic velocities significantly decreased compared to baseline values (at T1, T2). Significant modifications of the pulsatility index (PI) and resistance index occurred at T2 for PI and resistance index. No patient experienced an episode of bradycardia. Heart rate variations were not significantly different compared to T0. Neither hemodynamics nor cerebral effects were observed in the control group.

CONCLUSION: In summary, spinal anesthesia results in a very small but statistically significant reduction of CBF velocity in very elderly patients.