Key result
Intramuscular methoxamine 10 mg given before subarachnoid block reduced systolic arterial pressure hypotension compared to colloid and crystalloid fluid loading (47% vs 75%; OR 3.43, P=0.03).
Why the study?
Does methoxamine 10mg I/M prevent hypotension during subarachnoid block in elderly patients with fractured neck of femur compared to colloid and crystalloid fluid loading?
RCT (n=62)
Randomly selected
Does methoxamine 10mg I/M prevent hypotension during subarachnoid block in elderly patients with fractured neck of femur compared to colloid and crystalloid fluid loading?
Prophylactic intramuscular methoxamine significantly reduces the incidence of hypotension and the need for rescue vasopressors during subarachnoid block in elderly patients compared to fluid loading.
Answers are grounded in this paper and cite their sources.
Supports IM methoxamine prophylaxis before spinal block in elderly hip fracture patients; extends RCT evidence versus fluid loading.
In elderly patients spinal Anaesthesia Subarachnoid block (SAB) induces hypotension. We have studied two different methods to prevent hypotension during SAB in elderly patients, One method is 6% Heta -starch (Haes – steril) (Colloid) and crystalloid and second method methoxamine 10mg I/M.We have selected 62 (sixty two) patients aged between 60 to 85 years with Fractured Neck of femur need surgical fixation. Randomly selected two group One group HS, n = 32 received 6% Heta starch (Haes-steril) 500ml Followed by Hartman’s Solution 500ml. Another group MX, n = 30 received bolus injection of methoxamine (Adrenergic alpha-1 Receptor agonists)10mg I/M 10mins before induction of SAB.SAB done with 0.5% Bupivacaine 2.25-3.0 ml. Non-invasive arterial pressure was measured initially before SAB and then every 2 mins intervals from 0 to 45 mins and at 5mins. intervals thereafter. Hypotension was defined as 25% decrease from Baseline Systolic arterial pressure (SAP) or mean Arterial pressure (MAP). Methoxamine 2mg I/V was given if systolic arterial pressure (SAP) decreased to <100mm. of Hg. Patient data, sensory level and blood loss were similar in two groups. Both the MAP & SAP initially increased from Baseline until induction of SAB and then Decreased for about 30mins. In both groups but remained higher in MX. (p < 0.05) group. In MX (p < 0.05) group heart rate decreased from Baseline but less than HS group at all times from 2 to 60min. (p < 0I) Similarly the SAP Hypotension (47% VS 75%, P = 0.03OR = 3.43 ) and MAP Hypotension (47% VS 67% P = 0.09 OR = 2.51 ) was less in MX than in group HS. Use of Methoxamine I/V for rescue (27% VS 53% P = 0.04 OR = 3.11 ) was less in group MX. Than in group HS. We Concluded that Methoxamine 10 mg. I/M given 10 mins. Before SAB in normovolaemic elderly patients reduced subsequent SAP and MAP Hypotension, HR and need for rescue vasopressor thereby compared with a combination of Colloid and crystalloid (6% Haes-steril 500ml+500ml Hartman’s solution.)
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Barbhuiya et al. (2013) conducted an RCT in Fractured neck of femur (n=62). Methoxamine vs. 6% Heta-starch 500ml followed by Hartman's Solution 500ml was evaluated on Systolic arterial pressure (SAP) hypotension (25% decrease from baseline) (OR 3.43, p=0.03). Intramuscular methoxamine 10 mg given before subarachnoid block reduced systolic arterial pressure hypotension compared to colloid and crystalloid fluid loading (47% vs 75%; OR 3.43, P=0.03).
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