Clinical Observation Of Hydroxyethyl Starch Coload In The Elderly Patients Undergoing Combined Spinal Anesthesia For Transurethral Resection Of The Prostate

Objective Observe the effect of Hydroxyethyl starch (130/0.4) coload in combination with small dose of ephedrine and Hydroxyethyl starch (130/0.4) coload prevention hypotension after spinal anesthesia in elderly people undergoing transurethral resection of the prostate.Methods 45 elderly patients(ASAⅠ～Ⅱ,aged 65～75 years) who undergoing transurethral resection of the prostate(TURP) to apply spinal anesthesia were randomly divided into three groups. Every group involved 15 patients, group A received Hydroxyethyl starch (130/0.4) coload in combination with small dose of ephedrine; group B received Hydroxyethyl starch (130/0.4) coload; group C receive lactated Ringer's solution for control group. All of patients received 0.5% Bupivacaine 10mg for spinal anesthesia at the L2-3 interspace with spinal -epidural needle. the speed of inject Bupivacaine was 0.2ml/s. solution was infused after induction of spinal anesthesia. The way of GroupA: every hydroxyethyl starch (130/0.4) 500ml solution mixed with ephedrine 10mg was infused in 30min with 10ml/kg after induction of spinal anaesthesia. The way of Group B: hydroxyethyl starch (130/0.4) solution was infused in 30min with 10ml/kg after induction of spinal anaesthesia. All of patients receive 6～8 ml/kg·h of lactated Ringer's solution after 30min. the way of Group C: patients receive 6～8 ml/kg·h of lactated Ringer's solution after induction of spinal anaesthesia. Observing and recording:the time of sensory blockade occur, the time of sensory blockade reaching maxlmum Plane, the maxlmum Plane of sensory blockade; the time of motor blockade occur, the time of motor blockade reaching maxlmum and evaluating motor blockade by modified Bromage scale, the change of SBP, DBP, HR of the base value(T₀), which was quiet for 10min in the operating room, and 5min(T₁), 10min(T₂), 15min(T₃), 20min(T₄ ), 25min(T₅ ), 30min(T₆), 40min(T₇) after intrathecal local anesthetic administration. The decline rate of SBP, the incidence of hypotension, bradyca- rdia, respiratory depression, nausea and vomit, shivering, obturator nerve reflex, retention of urine, post dural puncture headache(PDPH), TURPS et al.Results In group A, SBP,DBP,HR of T₁ were higher than T₀(P<0.05), SBP of the other time point were lower than T₀ (P<0.01),no significant differences of DBP,HR at the other time point with T₀; In group B and group C, SBP of all time point were lower than T0(P<0.01), DBP of T₁,T₂,T₃ were lower than T₀(P<0.01), no significant differences of HR at different time points with T₀(P>0.05); There were significant differences of SBP in group A, Group B , group C at T₁, T₂, T₃ time points(P<0.05), there is significant differences of DBP in group A compared with group C at T₁, T₂, T₃ time points(P<0.05),but no significant differences with it between group A and group B,group B and group C(P> 0.05). no significant differences of HR among three group(P>0.05). The decline rate of SBP in group A, Group B , group C were significant differences (P<0.01). There is significant differences between group C and group A of hypotension (P<0.01). but no significant differences between group A and group B, group B and group C (P>0.05). No significant differences among three groups of bradycardia, shivering (P > 0.05). no happened significant respiratory depression, nausea and vomit, obturator nerve reflex, retention of urine, post dural puncture headache(PDPH), TURPS, et al.Conclusion Hydroxyethyl starch (130 /0.4) coload in combination with small dose of ephedrine is better than Hydroxyethyl starch (130/0.4) coload of reducing the incidence of hypotension and offering stable hemodynamics in the elderly patients undergoing combined spinal anesthesia for transurethral resection of the prostate...