Intrathecal anaesthesia for the elderly patient : The influence of the induction position on perioperative haemodynamic stability and patient comfort

Ninety elderly (>65 y) patients were studied to assess the influence of patient position during induction of spinal anaesthesia on the incidence of perioperative hypotension and haemodynamic stability. Prior to induction of anaesthesia, Lactated Ringer's solution (8-10 ml/kg) was administered. In the Sitting Group, intrathecal anaesthesia was performed with the patient in the sitting position. In the Lateral Group, patients assumed the lateral decubitus position. In all cases hyperbaric bupivacaine (10 mg) was administered using a 25 gauge Quincke spinal needle. Patients were placed in the supine (and thereafter lithotomy) position immediately after withdrawing the spinal needle. Incremental doses of ephedrine (5 mg, i.v.) were administered in response to hypotension (>20% of baseline), nausea, vomiting, sweating, skin pallor or impaired consciousness. The mean arterial blood pressure, heart rate and the number of hypotensive episodes requiring ephedrine administration were unaffected by group affiliation. In the Sitting Group, nine patients received 24 doses of ephedrine 5 mg i.v. In the Lateral Group, 21 incremental doses of ephedrine were administered to nine patients. The incidence of nausea, vomiting, sweating and pallor were similar between the groups. Patient comfort was similar. In summary, the incidence of hypotension and hypotension-related adverse effects was similar when intrathecal anaesthesia was induced in the sitting or lateral position. Furthermore, subjective perception of the induction process or anaesthetic experience was not affected by patient position.