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October 8, 2024Journal of Perioperative Practice

High-dose phenylephrine infusion (35µg/kg/h) caused significantly more bradycardia (p=0.02) and reactive hypertension (p=0.03) than a 25µg/kg/h dose during spinal anaesthesia in elderly patients.

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Why the study?

Does 35 µg/kg/h phenylephrine infusion compared to 25 µg/kg/h prevent hypotension and maintain haemodynamic stability in elderly patients undergoing femur fracture fixation under spinal anaesthesia?

Population

60 elderly patients older than 60 years, ASA class I and II, undergoing femur fracture fixation surgery…

Comparison

Phenylephrine infusion at 35 µg/kg/h vs Phenylephrine infusion at 25 µg/kg/h

Design

RCT, White and black cards randomly allocated patients, double-blind

Key result

High-dose phenylephrine infusion (35µg/kg/h) caused significantly more bradycardia (p=0.02) and reactive hypertension (p=0.03) than a 25µg/kg/h dose during spinal anaesthesia in elderly patients.

Authors

MGMitra GolmohammadiSSShahryar SaneWKWesam R. Kadhum

Discussion

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Member takes

Overview

Lower phenylephrine doses may reduce bradycardia and hypertension risk in elderly spinal anesthesia; extends sparse RCT dose data without practice change.

Study Design

Type

RCT (n=60)

Blinding

Double-blind

Randomization

White and black cards

Structured PICO

Does 35 µg/kg/h phenylephrine infusion compared to 25 µg/kg/h prevent hypotension and maintain haemodynamic stability in elderly patients undergoing femur fracture fixation under spinal anaesthesia?

P
Population
60 elderly patients (>60 years) classified as ASA I and II undergoing femur fracture fixation surgery under spinal anaesthesia.
I
Intervention
Phenylephrine infusion at 35 µg/kg/h
C
Comparator
Phenylephrine infusion at 25 µg/kg/h
O
Outcome
Prevention of hypotension and haemodynamic stabilitysafety

Main Result

p-value: p=0.02 and 0.03

High-dose phenylephrine infusion (35 µg/kg/h) does not assure haemodynamic stability and increases the risk of bradycardia and reactive hypertension compared to 25 µg/kg/h in elderly patients undergoing spinal anaesthesia.

Cite This Study

Golmohammadi et al. (2024) conducted an RCT in Femur fracture fixation surgery under spinal anaesthesia (n=60). Phenylephrine infusion vs. 25µg/kg/h phenylephrine infusion was evaluated on Bradycardia and reactive hypertension (p=0.02 and 0.03). High-dose phenylephrine infusion (35µg/kg/h) caused significantly more bradycardia (p=0.02) and reactive hypertension (p=0.03) than a 25µg/kg/h dose during spinal anaesthesia in elderly patients.

synapsesocial.com/papers/6ab4873236ec8044794dd8a7https://doi.org/10.1177/17504589241274470
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1A Comparative Study of Infusion of Ephedrine and Phenylephrine on Hemodynamic Stability After Spinal Anesthesia in Elderly Patients Undergoing Lower Limb Orthopedic Surgeries2024 · 4 citations
  2. 2Hemodynamic effects of norepinephrine versus phenylephrine infusion for prophylaxis against spinal anesthesia-induced hypotension in the elderly population undergoing hip fracture surgery: a randomized controlled trial2020 · 16 citations
  3. 3Prophylactic IM Small-Dose Phenylephrine Blunts Spinal Anesthesia-Induced Hypotensive Response During Surgical Repair of Hip Fracture in the Elderly2002 · 17 citations
  4. 4Prophylactic IM Small-Dose Phenylephrine Blunts Spinal Anesthesia-Induced Hypotensive Response During Surgical Repair of Hip Fracture in the Elderly2002 · 18 citations
  5. 5Comparing prophylactic effect of phenylephrine and ephedrine on hypotension during spinal anesthesia for hip fracture surgery2016 · 13 citations