Effects of Continuous Intravenous Infusion of Methoxamine on the Intraoperative Hemodynamics of Elderly Patients Undergoing Total Hip Arthroplasty
Defeng Sun, Yue Wu, Lin Yang, Jun Han, Ruochuan Liu, Lijie Wang
Department of Anesthesiology, First Affiliated Hospital of Dalian Medical University, Dalian, China (mainland)
Med Sci Monit 2014; 20:1969-1976
Hemodynamic disturbances are common during continuous epidural anesthesia in elderly patients undergoing total hip arthroplasty. This study aimed to investigate the effects of methoxamine on the intraoperative hemodynamics in elderly patients undergoing total hip arthroplasty under epidural anesthesia.
Material and Methods: This prospective study included 150 elderly patients undergoing elective total hip arthroplasty under epidural anesthesia. Patients were randomly assigned into 5 groups (n=30 per group): a control group receiving saline (Group C), a dopamine group receiving 7 µg/kg/min dopamine (Group D), and methoxamine groups receiving 1, 2, or 3 µg/kg/min methoxamine (Groups M1, M2, and M3, respectively). Hemodynamic parameters were assessed 10 min before anesthesia (T1); 10 min (T2), 20 min, (T3), 30 min (T4), and 60 min (T5) after anesthesia; and at the conclusion of surgery (T6).
Results: At T2–T6, the mean arterial pressure, central venous pressure, cardiac output, stroke volume, stroke volume ratio, and pulmonary vascular resistance were higher in Groups D, M2, and M3 compared to Group C (p<0.05). Compared to Group D, the heart rate and rate pressure product were significantly lower in Groups M1–M3. Infusion volume, ephedrine dose, and postoperative 24-h urine volume were significantly lower and intraoperative urine volume was significantly greater in Groups D, M2, and M3 compared with Group C. Hypertension occurred more frequently in Group M3 than in any other group.
Conclusions: Continuous intravenous infusion of 2 µg/kg/min methoxamine is safe and effective in maintaining hemodynamic stability in elderly patients undergoing total hip arthroplasty.
Keywords: Aged, 80 and over, Arthroplasty, Replacement, Hip, Hemodynamics, Infusions, Intravenous, Intraoperative Period, Methoxamine - administration & dosage, Sympathomimetics - administration & dosage