Hemodynamic Effects of Dihydroergotamine in Combined Epidural and General Anesthesia

Ten patients (63-80 years of age) scheduled for elective hip arthroplasty in whom systemic hypotension developed after combined general and epidural anesthesia were investigated. The necessary invasive monitoring was placed under local anesthesia. In a steady state, a baseline hemodynamic profile (HP) was obtained including systolic and mean arterial pressures, heart rate, cardiac index, and systemic and pulmonary vascular resistance; cardiac output was estimated by thermodilution. A second HP was recorded 30 minutes later, after epidural anesthesia with bupivacaine 0.5% reached a T7 level of analgesia. After the induction of general anesthesia, a new HP was obtained. When the mean arterial pressure was decreased by 30% despite intravenous fluids, 10 μg/kg of dihydroergotamine (DHE) was given intravenously, and 10 minutes later another HP was obtained. DHE restored normal systemic arterial pressure but the cardiac index decreased significantly ( p < 0.05). These findings make DHE unsuitable for the purpose described.