Publication in refereed journal
香港中文大学研究人员 ( 现职)
| 郭志德教授 (麻醉及深切治疗学系) |
全文
| 数位物件识别号 (DOI) http://dx.doi.org/10.1111/j.1365-2044.1996.tb15051.x |
引用次数
Web of Sciencehttp://aims.cuhk.edu.hk/converis/portal/Publication/43WOS source URL
其它资讯
摘要This article reviews the current literature on the management of hypotension during subarachnoid block in the elderly. Hypotension results from blockade of the sympathetic nervous system, which causes decreases in both systemic vascular resistance and cardiac output. Abolition of normal cardiovascular reflexes is also important and may explain unexpected cardiac arrests during subarachnoid block. Untreated block in the elderly results in decreases in systolic arterial pressure, systemic vascular resistance and central venous pressure. Cardiac output appears not to decrease as has been previously reported and heart rate is affected by several different factors. Preload to the heart should be maintained during block by giving adequate intravenous fluids and 8 ml.kg(-1) is satisfactory in most cases. Adequate preloading prevents decreases in cardiac output and unexpected cardiac arrests. In this respect, mild head down tilt is also beneficial. Ideally, intravenous fluid should be given as the block is developing. Excessive fluid administration serves no useful purpose and can cause fluid overload and urinary retention. If systolic arterial pressure decreases by more than 25%, or to below 90 mmHg, treatment with a vasopressor is indicated. The efficacy of ephedrine has recently been questioned, as it is a poor vasoconstrictor and inotrope in the elderly. The alpha-adrenoceptor agonists may prove a more logical choice, because they increase both peripheral resistance and preload. Metaraminol by infusion (<10 ml.h(-1) of 10 mg in 20 ml) has been used successfully, though hypertension can occur.
着者Critchley LAH
期刊名称Anaesthesia
出版年份1996
月份12
日期1
卷号51
期次12
出版社BLACKWELL SCIENCE LTD
页次1139 - 11http://aims.cuhk.edu.hk/converis/portal/Publication/43
国际标準期刊号0003-2409
电子国际标準期刊号1365-2044
语言英式英语
关键词anaesthetic techniques regional, spinal; complications, hypotension, cardiac arrest; patient population, elderly; vasopressors, ephedrine, metaraminol, phenylephrine
Web of Science 学科类别Anesthesiology; ANESTHESIOLOGY
